{"id":1769,"date":"2004-10-01T01:00:00","date_gmt":"2004-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/pneumomediastin-spontanechirurgie-en-urgence-ou-traitement-symptomatique\/"},"modified":"2018-10-20T18:39:34","modified_gmt":"2018-10-20T16:39:34","slug":"pneumomediastin-spontanechirurgie-en-urgence-ou-traitement-symptomatique","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/pneumomediastin-spontanechirurgie-en-urgence-ou-traitement-symptomatique\/","title":{"rendered":"PNEUMOMEDIASTIN SPONTANE\nCHIRURGIE EN URGENCE OU TRAITEMENT SYMPTOMATIQUE ?"},"content":{"rendered":"

2004<\/strong><\/p>\n

S Manfredi, O Nouel, E Briens, J Bousser.<\/em><\/p>\n

H\u00e9patologie <\/strong>– \u00a02004-07-10 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Le pneumom\u00e9diastin spontan\u00e9 est une pathologie rare, il survient g\u00e9n\u00e9ralement apr\u00e8s des efforts \u00e0 glotte ferm\u00e9e, chez des sujets jeunes. Si le diagnostic de pneumom\u00e9diastin est relativement ais\u00e9, le diagnostic \u00e9tiologique et la prise en charge th\u00e9rapeutique ne sont pas faciles : quels examens doivent \u00eatre faits ? dans quel ordre ? faut il op\u00e9rer en urgence ? quelle surveillance doit \u00eatre r\u00e9alis\u00e9e ? quand peut on r\u00e9alimenter le patient ?\u2026<\/p>\n

Deux cas de pneumom\u00e9diastin spontan\u00e9 ont \u00e9t\u00e9 pris en charge r\u00e9cemment au CH de Saint Brieuc. Ces 2 cas sont survenus chez de jeunes patients apr\u00e8s des efforts cons\u00e9quents (effort de vomissement et effort \u00e0 glotte ferm\u00e9e lors d’1 d\u00e9m\u00e9nagement), 2 \u00e9tiologies diff\u00e9rentes ont pu \u00eatre retenues (rupture alv\u00e9olaire et syndrome de Mallory Weiss). Dans les 2 cas la d\u00e9marche diagnostique et la prise en charge th\u00e9rapeutique ont \u00e9t\u00e9 sensiblement identiques. Dans les 2 cas l’\u00e9volution a \u00e9t\u00e9 favorable, permettant 1 r\u00e9 alimentation progressive \u00e0 J3.<\/p>\n

Les examens en urgence apr\u00e8s mise en \u00e9vidence du pneumom\u00e9diastin, ont \u00e9t\u00e9 soit 1 transit \u00e0 la gastrographine suivi d’1 scanner thoraco-abdominal pour le 1er , un scanner thoraco-abdominal suivi d’1 transit \u00e0 la gastrographine pour le second. Ces 2 examens ne permettaient pas de localiser la br\u00e8che responsable du pneumom\u00e9diastin, mais permettaient d’\u00e9liminer 1 l\u00e9sion tumorale ou 1 malformation et d’appr\u00e9cier la gravit\u00e9 du pneumom\u00e9diastin. Dans les 2 cas la fibroscopie gastrique en urgence a \u00e9t\u00e9 r\u00e9cus\u00e9e, dans la crainte d’aggraver le pneumom\u00e9diastin existant.
\nA distance, apr\u00e8s am\u00e9lioration de la symptomatologie et contr\u00f4le de la stabilit\u00e9 ou de la r\u00e9gression du pneumom\u00e9diastin 1 fibroscopie gastrique \u00e9tait r\u00e9alis\u00e9e permettant le diagnostic d’1 syndrome de Mallory Weiss en voie de cicatrisation.
\nPour le second patient nos confr\u00e8res pneumologues \u00e9taient sollicit\u00e9s quand \u00e0 l’opportunit\u00e9 d’1 fibroscopie bronchique : celle ci \u00e9tait r\u00e9cus\u00e9e ; l’origine bronchopulmonaire des pneumom\u00e9diastins \u00e9tant la rupture d’alv\u00e9oles p\u00e9riph\u00e9riques, inaccessibles \u00e0 1 examen endoscopique.
\nLes 2 patients quittaient le service apr\u00e8s 7 \u00e0 8 j d’hospitalisation, apr\u00e8s disparition compl\u00e8te de la symptomatologie, r\u00e9 alimentation sans probl\u00e8me, contr\u00f4le de l’absence de complication infectieuse, r\u00e9gression du pneumom\u00e9diastin initial.
\nDans les 2 cas 1 scanner thoracique \u00e0 1 mois \u00e9tait r\u00e9alis\u00e9 pour s’assurer de la compl\u00e8te gu\u00e9rison.<\/p>\n

Ces 2 patients illustrent les 2 \u00e9tiologies les plus fr\u00e9quentes de pneumom\u00e9diastin spontan\u00e9, habituellement d’\u00e9volution favorable, mais n\u00e9cessitant en urgence une prise en charge rigoureuse afin de ne pas retarder une \u00e9ventuelle chirurgie qui doit \u00eatre, en cas de complication, la plus pr\u00e9coce possible. Dans ces 2 cas, en l’absence d’\u00e9tiologie \u00e9vidente lors des examens compl\u00e9mentaires initiaux, et en l’absence de complication pulmonaire ou infectieuse l’indication op\u00e9ratoire en urgence n’a pas \u00e9t\u00e9 port\u00e9e et la prise en charge a consist\u00e9e en une simple surveillance et un traitement symptomatique.<\/p>\n

La litt\u00e9rature sur le sujet est tr\u00e8s abondante, avec une prise en charge variable selon les \u00e9quipes, ne permettant pas de d\u00e9gager une attitude consensuelle. L’analyse de cette litt\u00e9rature confirme la n\u00e9cessit\u00e9 d’1 certain nombre d’examens compl\u00e9mentaires \u00e0 r\u00e9aliser en urgence : radiographie de thorax, scanner thoraco-abdominal et transit oesophagien. La plupart du temps aucune \u00e9tiologie n’est retrouv\u00e9e. Les examens endoscopiques (digestifs ou pulmonaires) en urgence sont proscrits. L’attitude th\u00e9rapeutique est tr\u00e8s controvers\u00e9e, certains auteurs pr\u00e9conisants une thoracotomie syst\u00e9matique, d’autres un traitement symptomatique syst\u00e9matique, et d’autres une surveillance attentive premi\u00e8re avec intervention chirurgicale d\u00e9s l’apparition de complication\u2026<\/p>\n","protected":false},"excerpt":{"rendered":"

2004 S Manfredi, O Nouel, E Briens, J Bousser. H\u00e9patologie – \u00a02004-07-10 –\u00a0CO – ________________________________ Le pneumom\u00e9diastin spontan\u00e9 est une pathologie rare, il survient g\u00e9n\u00e9ralement apr\u00e8s des efforts \u00e0 glotte ferm\u00e9e, chez des sujets jeunes. Si le diagnostic de pneumom\u00e9diastin est relativement ais\u00e9, le diagnostic \u00e9tiologique et la prise en charge th\u00e9rapeutique ne sont pas […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[3],"tags":[15],"class_list":["post-1769","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-15"],"yoast_head":"\nPNEUMOMEDIASTIN SPONTANE CHIRURGIE EN URGENCE OU TRAITEMENT SYMPTOMATIQUE ? - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/pneumomediastin-spontanechirurgie-en-urgence-ou-traitement-symptomatique\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"PNEUMOMEDIASTIN SPONTANE CHIRURGIE EN URGENCE OU TRAITEMENT SYMPTOMATIQUE ? 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