Surgical treatment of acute purulent mediastinitis

Abstract

During the last 15 years we have treated 147 patients with acute purulent mediastinitis (APM). According to the aetiology of the disease, 2 major groups were defined. The first group included the cases of oesophageal origin--112 patients (dilatation--38 patients, foreign body extraction--29 patients, lye injuries--11 patients, oesophagoscopy--8 patients, sharp foreign body--6 patients). The second group consisted of patients with mediastinitis of non-oesophageal origin--35 patients (tracheo-bronchial disease--21 patients, tooth infection--8 patients, cervical infection). Symptoms of the mediastinal infection were typical; nevertheless, early diagnosis (within first 12 h) was obtained in only 43.5% of cases. Therapy for all patients included general stabilisation, broad spectrum antibiotics and immunotherapy. In 86 patients, mediastinal drainage was performed with additional suture of the oesophageal wall or plication with a gastric or diaphragmatic patch in 9 cases. Oesophagectomy and delayed colon transplant was the method used in 61 patients. Mortality included 21 patients (14.3%). The cause was broncho-pneumonia in 9 patients, endotoxic shock in 7 and renal failure in 3 patients.

Extension injury of the thoracic spine with rupture of the oesophagus and successful conservative therapy of concomitant mediastinitis

“…The mortality rate of this condition is up to 40% [4,11,12,14,16,18,22]. Cherveniakov et al [6] emphasise the importance of early treatment, and report a delayed diagnosis due to failure to recognise the clinical symptoms in 55% and due to misinterpretation of X-ray findings in another 25% in their series of 147 patients. Generally, a delay between diagnosis and therapy of more than 24 h has been found to adversely affect the outcome [4,9].…”