Acute Mediastinitis. Retrospective Analysis of 12 Cases

Zelada, Ismael; Farina, César; Lee, Chong; Agüero, Ángel

doi:10.18004/sopaci.2019.abril.12-15

Cited by 1 publication

(8 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite its low incidence, it is associated with a high mortality rate. 1 Among the most frequent causes are esophageal perforation, infectious processes (abscesses) at the level of the neck or of odontogenic origin, and infection secondary to cardiovascular surgery due to sternotomy. 2,3 In particular, iatrogenic lesions are the most common cause of mediastinitis secondary to esophageal perforation.…”

Section: Introductionmentioning

confidence: 99%

“…The most frequent clinical manifestations are retrosternal pain, dysphagia, and fever exploration is not recommended except for the extraction of foreign bodies. 1 The treatment of choice for the management of mediastinitis due to esophageal perforation is surgical drainage and debridement of the necrotic tissue, various surgical approaches have been described depending on the location of the perforation, either by cervicotomy, thoracotomy or thoracoscopy. [7][8][9][10] In addition to surgical treatment, it is essential to achieve adequate control of the septic focus with early initiation of broad-spectrum antibiotic therapy, which can later be narrowed according to the microorganism obtained in the drainage cultures.…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9][10] In addition to surgical treatment, it is essential to achieve adequate control of the septic focus with early initiation of broad-spectrum antibiotic therapy, which can later be narrowed according to the microorganism obtained in the drainage cultures. 1,11 Additionally, the patient should remain nothing by mouth, so it is indicated to start enteral or parenteral nutritional support early. 1,4,11 CASE REPORT 83-year-old female patient with a history of left saphenectomy due to venous insufficiency with difficult intubation two days prior to emergency consultation for dyspnea, hemoptysis, chest pain radiating to the dorsal region and right hemifacial edema.…”

Section: Introductionmentioning

confidence: 99%

“…1,11 Additionally, the patient should remain nothing by mouth, so it is indicated to start enteral or parenteral nutritional support early. 1,4,11 CASE REPORT 83-year-old female patient with a history of left saphenectomy due to venous insufficiency with difficult intubation two days prior to emergency consultation for dyspnea, hemoptysis, chest pain radiating to the dorsal region and right hemifacial edema. Upon admission in poor general conditions, heart rate 120 beats per minute, respiratory rate 25 per minute, oxygen saturation down to 82% on room air with supplemental oxygen requirement per ventury at 40% to achieve a saturation of 90%.…”

Section: Introductionmentioning

confidence: 99%

“…

and in some cases there may be deterioration of the respiratory status. 1,4,5 Contrast computed axial tomography is the imaging modality of choice for the diagnosis and follow-up of this pathology. Imaging findings that suggest the presence of esophageal perforation with mediastinitis are: fluid collection in the mediastinal space, extraluminal gas, pleural effusion, attenuation of mediastinal fat, mediastinal widening, thickening of the esophageal walls, and contrast medium extravasation.

…”

mentioning

confidence: 99%

See 4 more Smart Citations

Iatrogenic esophageal perforation with mediastinitis, multidisciplinary management: a case report

Mancera¹,

Ariza²,

Pelaez³

et al. 2021

Int Surg J

View full text Add to dashboard Cite

Acute mediastinitis is a low incidence pathology, but it is associated with a high mortality rate. Iatrogenic lesions are the most common cause of mediastinitis secondary to esophageal perforation. Early diagnosis and surgical treatment are the most important factors in the treatment of patients with this condition. 83-year-old female patient, with a history of left saphenectomy due to venous insufficiency with difficult intubation two days prior to the emergency consultation. She was admitted to the emergency room due to dyspnea, hemoptysis, chest pain, and right hemifacial edema. A chest tomography was performed with findings suggestive of esophageal perforation or airway injury. Later, in an upper digestive tract study, extravasation of the contrast medium was documented in the right posterolateral wall of the cervical esophagus with a collection in the middle mediastinum. The patient was taken for drainage of mediastinitis by right thoracoscopy and the presence of a perforation in the cervical esophagus was confirmed with an intraoperative endoscopy. Esophageal repair was performed, with drainage of the prevertebral space and the superior mediastinum by a left longitudinal cervicotomy. Postoperatively, she received antibiotic and enteral nutritional support by a nasojejunal tube. Low output fistula of the cervical esophagus, organized by a drain, was documented, which closed after 4 weeks of conservative management. Iatrogenic esophageal perforation with mediastinitis is a very rare entity with a high mortality. Early surgical treatment is the most important prognostic factor in patients with mediastinitis due to esophageal perforation.

show abstract

Section: Introductionmentioning

confidence: 99%