Sub-Xiphoid Abscess and Sinus after Open Heart Surgery

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Sub-xiphoid abscess and sinus after open heart surgery (n=5). Intervention: Partial excision of temporary epicardial pacemaker wires. Primary outcome: Sub-xiphoid abscess and sinus formation.

Q: What does this research mean for the field?

Retained intra-thoracic fragments of cut temporary pacemaker wires can undergo corrosion and cause chronic inflammation, resulting in delayed sub-xiphoid abscess and sinus tract formation after open heart surgery. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ahmed Hamdy Elayouty; H. Elayouty Ahmed

doi:10.14302/issn.2641-5518.jcci-22-4171

January 1, 2022Journal of Clinical Case reports and ImagesOpen Access

Sub-Xiphoid Abscess and Sinus after Open Heart Surgery

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Key result

Partially excised temporary epicardial wires can trigger late sub-xiphoid abscesses secondary to wire corrosion.

n=5

Why the study?

Sub-xiphoid abscess and sinus formation after open heart surgery related to retained intra-thoracic pacemaker wire portions causing chronic inflammation were not well characterized.

Does complete surgical extraction of retained temporary pacing wires resolve late sub-xiphoid abscesses and sinus tracts occurring after open-heart surgery?

Key Points

To evaluate the safety of cutting temporary epicardial pacemaker wires flush at the skin and assess complications arising from retained internal wire segments.
Reviewed 5 consecutive patients presenting with chronic draining sub-xiphoid sinuses and abscesses between 15th January 2022 and 1st March 2022 at Abo-Khalifa Emergency Hospital in Ismailia, Egypt.
Patients underwent contrast-enhanced chest computed tomography, tract localization with methylene blue under general anesthesia, and surgical exploration with traction extraction of retained wires.
Sub-xiphoid abscess and sinus evolution occurred 18 to 60 months after initial open heart valve procedures (mitral and/or aortic replacement, or CABG).
Retained intra-thoracic wire remnants exhibited metal corrosion that triggered chronic foreign-body inflammation and sinus tracks; surgical exploration successfully removed 1 to 2 offending wires per patient.

Study Design

Type

Case Report (n=5)

Multicenter

No

Structured PICO

Does complete surgical extraction of retained temporary pacing wires resolve late sub-xiphoid abscesses and sinus tracts occurring after open-heart surgery?

P

Population

5 adult patients (60% female, mean age 42 years) who developed sub-xiphoid abscesses and sinuses 18 to 60 months after open heart surgery due to retained temporary epicardial pacemaker wires.

E

Exposure

Surgical exploration, methylene blue injection into the sinus track, excision of the track, and complete extraction of the retained temporary pacing wires.

O

Outcome

Successful extraction of the retained pacemaker wires and resolution of the sub-xiphoid abscess and sinus track.safety

Incomplete removal of temporary epicardial pacing wires can lead to late corrosion, sub-xiphoid abscesses, and sinus tracts, underscoring the clinical importance of complete wire extraction before patient discharge.

Limitations

Small sample size with only 5 cases reported
Single-center experience
Lack of a comparator group

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Implication

May warrant complete temporary wire removal to avoid delayed abscesses; leaves open optimal management strategies after cardiac surgery.

Abstract

Sub-Xiphoid Abscess and Sinus after Open Heart Surgery drains its contents through a sinus around the lowermost portion of the xiphoid process.The duration between open heart surgery and evolution of these abscesses varied between 18 and 60 months.Valve surgeries were mitral and/or aortic valve replacement.Surgeons usually insert pacemaker wires to control any persistent post-operative arrhythmias that can affect hemodynamic circulation.On the day of discharge, some surgeons (not in our center) usually excise the pacemaker wires.Results: The remaining intra-thoracic portions underwent some degree of corrosion that caused a state of chronic inflammation, sinus track formation and abscess evolution.This indicated radiological examination and surgical exploration to extract these foreign bodies.These 5 cases were diagnosed and operated upon between 15th January 2022 and 1stMarch2022, all at Abo-Khalifa Emergency Hospital-Ismailia, Egypt.Conclusions: This confirms the significance of total withdrawal of the external pacemaker wires.Surgeons should not apply tight sutures at the site of insertion of the wires.

Discussion

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Cite This Study

Elayouty et al. (2022) conducted a case report in Sub-xiphoid abscess and sinus after open heart surgery (n=5). Partial excision of temporary epicardial pacemaker wires was evaluated on Sub-xiphoid abscess and sinus formation. Partial excision of temporary epicardial pacemaker wires after open-heart surgery resulted in sub-xiphoid abscesses and sinus tracks 18 to 60 months postoperatively due to wire corrosion.

synapsesocial.com/papers/6ac591f938c9af7ead383480 https://doi.org/10.14302/issn.2641-5518.jcci-22-4171

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Sub-Xiphoid Abscess and Sinus after Open Heart Surgery

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Sub-Xiphoid Abscess and Sinus after Open Heart Surgery

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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