[Pleuro-pericardial cysts, treatment by video-assisted surgery]

Three cases of symptomatic pleuro-pericardic cysts were treated with video-assisted surgery. Complete exercises of the cysts was possible in all cases. The follow-up was uneventful and hospitalization was 4 to 5 days. Pleuro-pericardic cysts represent 5 to 10% of the mediastinal tumours. Clinical latency and a constantly benign course are characteristic features. In most cases, tomodensitometry confirms the diagnosis. The diagnosis may be uncertain only in symptomatic forms (atypical localization, high density on tomodensitometry). In these cases, video-assisted surgery is an interesting alternative to transparietal punction-evacuation or to exeresis via thoracotomy.

Infectious complications of endoscopic retrograde cholangio-pancreatography managed in a surgical unit

The immediate infectious pancreato-biliary complications of endoscopic retrograde cholangiopancreatography (ERCP) warranting transfer to a surgical unit are analyzed, in order to evaluate their frequency and severity as well as means of treatment and prevention. Thirty complications of this type were observed in a series of 3226 ERCP performed with or without endoscopic sphincterotomy (ES) over a six year period (0.9%). ES had been performed in 12 of 30 cases, but the complication could not be attributed to the procedure. Post-ERCP complications included: acute cholangitis: 16 cases (53%); acute cholecystitis: 8 cases (26%); acute pancreatitis: 4 cases (13%); infected pancreatic pseudocyst: 2 cases (6%). The global mortality rate was 16.6% (five patients): Four of the deaths were due to septic complications. Twenty-seven of the 30 patients underwent surgery, and three of them died (11%). Acute cholangitis was responsible for most of the deaths (four of five) and the mortality appeared related to the long interval before surgery (three of four deaths). Strict adherence to good endoscopic procedures (aseptic conditions, injection without excessive pressure, antibiotic prophylaxis) and decompression of the biliary tract (nasobiliary drain or transhepatic catheter) should help reduce the frequency of post-ERCP complications, and especially cholangitis, which appears to benefit from early surgical treatment.