A Case of Purulent Pericarditis Caused by Baceteroides fragilis Successfully Treated with Pericardiotomy Using Left Small Thoracotomy

Kenshi Yoshimura＊	Tomoyuki Wada＊	Hideyuki Tanaka＊
Takashi Shuto＊	Madoka Kawano＊	Takayuki Kawashima＊
Tadashi Umeno＊	Kaoru Uchida＊	Hirofumi Anai＊
Shinji Miyamoto＊

（Depertment of Cardiovascular Surgery, Oita University Hospital＊, Oita, Japan）

A 70-year-old woman who was bedridden because of right hemiplegia attributable to a history of cerebral hemorrhage underwent surgical thrombectomy for pulmonary embolism four years previously. Symptoms of heart failure appeared one year previously, and she was diagnosed with constrictive pericarditis and had been treated with medication by a previous doctor. In the current situation, she visited the previous doctor with the chief complaint of fever, and pericardial effusion was observed on echocardiography. Cardiac tamponade was suspected and she was transferred to our hospital. She was then diagnosed with purulent pericarditis because purulent fluid was observed during pericardiocentesis drainage. Bacteroides fragilis was isolated from the culture of the abscess. The abscess was resistant to conservative antibiotic therapy;therefore, we performed a pericardiotomy with a left small thoracotomy. The pleural effusion was found to be negative for culture and the patient exhibited a good postoperative course. Purulent pericarditis is refractory with poor prognosis. An appropriate surgical procedure must be chosen considering the patient’s activities of daily living. Here, we report a surgical case wherein we chose the left thoracotomy approach and achieved positive results.
　　

Jpn. J. Cardiovasc. Surg. 49:12-15（2020）

Keywords：purulent pericarditis;constrictive pericarditis;pericardiotomy;small thoracotomy