Treatment of mediastinitis using video-assisted thoracoscopic surgery

Cho, Jeong Su; Kim, Yeong‐Dae; Hoseok, I; Lee, Sang Kwon; Jeong, Yeon Joo

doi:10.1016/j.ejcts.2008.05.034

Cited by 48 publications

(33 citation statements)

References 18 publications

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“…In their series, all patients that underwent both cervicotomy and thoracotomy survived. More recently, less invasive approaches successfully employing thoracoscopic or mediastinoscopic drainage have been reported [11,14,[48][49][50][51][52][53][54][55].…”

Section: Review: Descending Necrotising Mediastinitis E Weaver Et Almentioning

confidence: 99%

Descending necrotising mediastinitis: two case reports and review of the literature

Weaver¹,

Nguyen²,

Brooks³

2010

Eur Respir Rev

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Descending necrotising mediastinitis is a rare and serious infection with a high mortality rate, which complicates pharyngeal or odontogenic infection. Early recognition and treatment are essential in order to minimise morbidity. Evaluation with computed tomography is necessary to confirm the diagnosis and facilitate surgical planning. In addition to prompt empirical antiobiotic therapy, surgical intervention is necessary in nearly all cases. Surgical drainage and debridement may be performed through cervicotomy alone, or through combined cervicotomy and thoracotomy, depending upon the extent of disease. Hyperbaric oxygen therapy may play an auxiliary role. We present two recent cases with characteristic imaging findings, and review the relevant literature. KEYWORDS: Computed tomography, mediastinitis CASE ONEA 60-yr-old male presenting with neck swelling, dysphagia and hoarseness had been extubated 2 days previously following a pneumonia. He had a past medical history of laryngeal cancer treated 10 yrs ago with external beam radiation and chemotherapy. On examination he had bilateral diffuse neck erythema, oedema and right-sided induration. Fibre-optic laryngoscopy showed scabbing of the right hypopharynx and erythematous swelling of the false vocal folds, aryepiglottic folds, and epiglottis. Over the course of 12 h, he developed septic shock with a blood pressure of 70/ 30 mmHg, heart rate of 135 beats?min, and a temperature of 103uF. He was started empirically on vancomycin and piperacillin/tazobactam. After stabilisation in the intensive care unit (ICU), computed tomography (CT) imaging of the neck and chest was performed. There was a large amount of subcutaneous air tracking into the deep fascial planes of the anterior neck, oedematous laryngeal mucosa, and bilateral loculated fluid collections tracking throughout the anterior neck extending to the superior mediastinum ( fig. 1). CT imaging of the chest showed a complex air and fluid collection in the anterior mediastinum extending to the base of the neck ( fig. 2). After review of the images, the patient was taken to the operating room for a combined procedure performed by both head and neck surgeons and thoracic surgeons. Bilateral anterior neck dissections were performed, and blunt dissection, irrigation and debridement were carried out to several centimeters below the sternal manubrium. Penrose drains were left in place. Then, left anterior thoracotomy with debridement of the anterior mediastinum, left pleural decortication and a pericardial window were performed by the thoracic surgeons. Microbiology of the anterior mediastinal fluid grew multiple organisms including Fusobacterium, Prevotella, Bacteroides fragilis, Peptostreptococcus, and a heavy growth of Streptococcus intermedius. Pathology of the pharyngeal lesions showed necrosis and granulation tissue. No neoplasm was identified. The patient later received a tracheostomy and pectoralis myocutaneous flap repair of the neck without sequelae. His total ICU length of stay was 32 days, and hi...

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Section: Review: Descending Necrotising Mediastinitis E Weaver Et Almentioning

confidence: 99%

Descending necrotising mediastinitis: two case reports and review of the literature

Weaver¹,

Nguyen²,

Brooks³

2010

Eur Respir Rev

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“…Authors advocating the use of median sternotomy claim the wide exposure of the infection area as an advantage, whiles authors opposing the use of sternotomy claim the risk of sternal osteomyelitis and insufficient exposure of the posterior basal area of the left hemithorax [14]. There is literature reporting the Desendan Nekrotizan Mediastinit / Descending Necrotizing Mediastinitis use of minimal invasive approach of thoracoscopic surgery to be enough and applicable in the treatment of DNM [15]. In our clinical experience thoracotomy was superior over thoracoscopic surgery in terms of mechanical debridement, and with thoracotomy the expected complete mediastinopleural connection was established after failure with thoracoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

Mediastinal Irrigation in the Treatment of Descending Necrotizing Mediastinitis

Yazıcı¹

2015

Ann Clin Anal Med

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ÖzetDesendan nekrotizan mediastinit, morbidite ve mortalite riski oldukça yüksek seyreden, nadir görülen klinik bir durumdur. Erken tanı, etkin antibiyoterapi ve cerrahi drenaj tedavi yönetiminin temel prensibini oluşturmaktadır. Kliniğimizde DNM nedeniyle takip ve tedavi edilen iki olgunun tedavi stratejisini sunmak ve daha önceki çalışmalar ile sonuçları karşılaştırmayı amaçladık. Mortalite riski yüksek bu durumun tedavisinin mediastinal ve plevral irrigasyon ile birlikte cerrahi drenaj ve debridman olduğu kanaatindeyiz. Anahtar KelimelerDesendan; Nekrotizan; Mediastinit; Cerrahi; İrrigasyon Abstract Descending necrotizing mediastinitis (DNM) is a rare clinical condition associated with high risk morbidity and mortality rate. Early diagnosis, effective antibiotherapy, and surgical drainage constitute the main principle of management. We present our treatment strategy of two cases of DNM and compare our results with previous studies. We believe the treatment of this high mortality rate condition should include both mediastinal and pleural irrigation together with complete surgical drainage and debridement

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“…13 With regard to minimally invasive surgery, two recently published studies are of particular interest, given that they examine VATS as a treatment for ANM14 (with a mortality rate of 16.7%), and for mediastinitis caused by oesophageal perforation, also performing the oesophageal repair using VATS. 9 We don't have enough VATS experience for treat this urgent pathology with minimal invasion, but, in expert hands it can be a proper treatment with good results published. 6,10 One of the factors influencing survival is the time passed between onset of symptoms and diagnosis, with late diagnosis being related to lower survival rates: 13,15 in the present series it can be observed that patients diagnosed beyond the initial 24 h have half the chance of survival as those diagnosed before.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, posterolateral thoracotomy is carried out in order to drain the mediastinal cavity, although some recent published studies report a minimally invasive approach using videothoracoscopy 6,9 in cases of ANM and even oesophageal perforations. In patients for whom the origin of the mediastinitis is buccocervical, the cervical approach with widereaching debridement appears to be crucial and in cases of oesophageal origin, it is essential to repair the oesophagus.…”

Section: Discussionmentioning

confidence: 99%

Surgery for acute mediastinitis in oesophageal perforations and descending necrotising infection: complications, mortality and protective factors

et al. 2011

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Acute mediastinitis is a life-threatening situation that is associated with high rates of morbidity and mortality. The most common causes of mediastinitis are: oesophageal perforation, acute necrotising mediastinitis (ANM) and post-sternotomy mediastinitis. The aim of this study was to analyze prognostic factors and the differences between mediastinitis from various origins. A retrospective analysis was carried out on all patients operated on for acute mediastinitis between 2000 and 2009. Surgical interventions were performed on 33 patients (69.7% male), the majority as a consequence of oesophageal perforation (21 cases). The overall mortality rate was 30%. Better survival was seen in subjects less than 60 years of age, subjects with no comorbidities, and subjects who had undergone early tracheotomy. Patients with ANM were younger, had less comorbidities, diagnosed later and required more repeat interventions compared to those patients who had mediastinitis caused by oesophageal perforations. Mortality was lower in the ANM group, but this was not statistically significant. Protective factors in mediastinitis are: early diagnostic and treatment, age under 60 years, absence of major comorbidity and early tracheotomy.

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Treatment of mediastinitis using video-assisted thoracoscopic surgery

Cited by 48 publications

References 18 publications

Descending necrotising mediastinitis: two case reports and review of the literature

Descending necrotising mediastinitis: two case reports and review of the literature

Mediastinal Irrigation in the Treatment of Descending Necrotizing Mediastinitis

Surgery for acute mediastinitis in oesophageal perforations and descending necrotising infection: complications, mortality and protective factors

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