Via Research Recognition Day Program VCOM-Carolinas 2025

Case Reports

PECTUS BAR REMOVAL SECONDARY TO PERICARDITIS IN A YOUNG PATIENT WITH CROHN'S DISEASE Holden Lewis OMS-III, Anthony Chaknis OMS-III, Kelly Champlin DO, Rachel Groening DO, Geoff Boyer DO, Juan Camps MD VCOM Carolinas, Spartanburg, SC 1; HCA Healthcare Grand Strand Medical Center, Myrtle Beach, SC 2, Prisma Health Children's Hospital Midlands, Columbia, SC 3 Introduction Imaging

Discussion

References - Removal of Nuss bar was performed. Procedure and immediate post-operative period were uncomplicated - Patient has followed up in clinic with multidisciplinary teams for continued monitoring. Other changes in his care include transition to ustekinumab for Crohn’s Disease. To date, patient has not had recurrence of pericardial effusions or episodic pain. - This case underscores the importance of thorough preoperative evaluation and ongoing monitoring in patients undergoing Nuss bar procedure - Furthermore, it highlights the need for heightened clinical awareness regarding the potential for complications like pericarditis following placement, especially in inflammatory and immunocompromised patients. • 1. Hebra A, Calder BW, Lesher A. Minimally invasive repair of pectus excavatum. J Vis Surg. 2016 Apr 5;2:73. doi: 10.21037/jovs.2016.03.21. PMID: 29078501; PMCID: PMC5637818. • 2. Das BB, Dodson M, Guzman A. Recurrent pericarditis in an adolescent with Crohn's colitis. Ann Pediatr Cardiol. 2020 Jul-Sep;13(3):256-259. doi: 10.4103/apc.APC_16_20. Epub 2020 Jul 2. PMID: 32863666; PMCID: PMC7437634. • 3. Image of pectus bar, Research gate: https://www.researchgate.net/figure/Bar-position-at postoperative-chest-X-rayposteroanterior-left-and-laterolateral_fig2_356434296 • 4. Image of cardiac effusion, Differential Diagnosis: https://ddxof.com/category/internal medicine/cardiology/ • 5. Image of ekg, ECG Diagnosis: Acute Pericarditis.

- Pectus excavatum manifests as a posterior depression of the sternum and adjacent costal cartilages - Beyond cosmetic concerns, it can impact cardiopulmonary function. - Surgical interventions, like the Nuss procedure, aim to rectify the deformity and enhance physiological outcomes but may have untoward side effects. - 17-year-old male with past medical history significant for Crohn’s Disease of the terminal ileum and pectus excavatum s/p titanium Nuss bar placement (Hallux 4.3) now suffering from pericarditis - He had been followed closely by Pediatric Surgery, Gastroenterology and Cardiology regarding his symptomology, which included pleuritic chest pain, left arm pain and shortness of breath - Recurrent moderate pericardial effusions were observed on serial echocardiograms and friction rub present on physical exam - His Crohn’s Disease was initially managed with adalimumab. Patient had trialed NSAIDs, colchicine, and steroids for pericarditis with no definite resolution - Discussions regarding Nuss bar as etiology were entertained and decision was made with patient and family to remove prematurely after less than 2 years in place Case Presentation

Figure 1. ECG showing pericarditis

Figure 2. TEE showing pericardial effusion

Figure 3 . Chest X-ray showing Pectus bar

2025 Research Recognition Day

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