Irrigation for MRSA Empyema after Surgery of Spontaneous Esophageal Rupture: Report of a Successfully Treated Case and Clinical Study in Japan

Takehiro Sakai, Koichi Sato, Yasuhiro Sudo, Masashi Koyanagi and Yoshie Hasegawa

Department of Surgery, Hirosaki City Hospital

We report a case of MRSA empyema successfully treated after surgery for spontaneous esophageal rupture. A 60-year-old man reporting abdominal pain after vomiting was diagnosed left pneumothorax and pleural effusion based on chest radiography. The day after onset, he suffered septic shock and was admitted. Thoracic drainage showed cloudy brown effusion, necessitating emergency thoracotomy under a diagnosis of esophageal rupture. The left wall of the lower esophagus was perforated and was repaired with direct sutures. Circulatory failure disturbed additional covering, and the patient suffered multiple organ failure after surgery. On postoperative day (POD) 1, irrigation with saline solution was started twice a day. Because MRSA was identified from pleural effusion and pus in the wound on POD 13, we started irrigation with increased saline solution and general antibiotics for MRSA. MRSA became negative in the pleural effusion on POD 30 and in the wound on POD 44. Pleural effusion became aseptic on POD 58, and the thoracic drainage tube was removed. The patient was discharged ambulatory on POD 108. Postoperative esophageal radiography and endoscopy confirmed a cure, and CT confirmed that left pulmonary volume was preserved. Regular irrigation with large amounts of saline solution is thus effective.

Key words
MRSA, empyema, spontaneous esophageal rupture

Reprint requests
Takehiro Sakai Department of Surgery, Hirosaki City Hospital
3-8-1 O-machi, Hirosaki, 036-8004 JAPAN

Accepted
September 27, 2006

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