Acute mediastinitis: evaluation of clinical risk factors for death in surgically treated patients

Jabłoński, Sławomir; Brocki, Marian; Kordiak, Jacek; Misiak, Piotr; Terlecki, Artur; Kozakiewicz, Marcin

doi:10.1111/j.1445-2197.2012.06252.x

Cited by 12 publications

(22 citation statements)

References 35 publications

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“…1,4 This entity has an approximate mortality of 18 to 44%, which can increase even up to 67% in patients with comorbidities, so that in most of these cases the patients will require admission and management in the intensive care unit. 12,14 Among the main causes of mediastinitis are esophageal perforation, infectious processes at the neck level or of odontogenic origin that configure a descending mediastinitis, postoperative mediastinitis secondary to an infection after esophageal and cardiac surgery, orotracheal intubation and endoscopic procedures. Specifically in the case of esophageal perforation mediastinitis, iatrogenic lesions correspond to approximately 70%, while 15% are due to spontaneous esophageal rupture.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically in the case of esophageal perforation mediastinitis, iatrogenic lesions correspond to approximately 70%, while 15% are due to spontaneous esophageal rupture. [2][3][4]12 The signs and symptoms that occur in mediastinitis are not very specific and since there are multiple etiologies, they will depend on the underlying cause. In most cases, regardless of the cause, patients present with fever, chills and tachycardia, specifically in the case of iatrogenic esophageal perforation mediastinitis, patients additionally present retrosternal pain, dysphagia and in some cases deterioration of the respiratory pattern.…”

Section: Discussionmentioning

confidence: 99%

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

Mancera¹,

Ariza²,

Pelaez³

et al. 2021

Int Surg J

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Mancera¹,

Ariza²,

Pelaez³

et al. 2021

Int Surg J

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“…14 Mediastinitis was defined by infectious material collected from the mediastinum. 15 In this study, patients with severe sepsis were defined as having a reduced general condition.…”

Section: Study Population and Treatmentmentioning

confidence: 99%

Management of Nonmalignant Tracheo- and Bronchoesophageal Fistula after Esophagectomy

Palmes

Kebschull

Bahde

et al. 2020

Thorac Cardiovasc Surg

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Background Tracheo- or bronchoesophageal fistula (TBF) occurring after esophagectomy represent a rare but devastating complication. Management remains challenging and controversial. Therefore, the purpose of this study was to evaluate the outcome of different treatment approaches and to propose recommendations for the management of TBF. Methods From 2008 to 2018, 15 patients were treated because of TBF and were analyzed with respect to fistula appearance, treatment strategy (stenting, endoscopic vacuum therapy and/or surgical reintervention) and outcome. Results In each case, the fistula was small, located close to the tracheal bifurcation and associated simultaneously (n = 6, 40%) or metachronously (n = 9, 60%) with an anastomotic leakage. Latter was covered by esophageal stents in six patients which in turn resulted in occurrence of TBF at a later time in five patients. Management of TBF included conservative therapy (n = 3), stenting (n = 6), or suturing (n = 6). Ten patients underwent rethoracotomy. Treatment failure was observed in eight patients (53%). In all patients, treatment was accompanied by progressive sepsis. On the contrary, all seven patients with successful defect closure remained in good general condition. Conclusion Fistula appearance was similar in all patients. Implementation of esophageal stents cannot be recommended because of possibility of TBF at a later time point. Surgery is usually required and should preferably be performed when the patient's condition has been optimized at a single-stage repair. Esophageal diversion can only be recommended in patients with persisting mediastinitis. The key element for successful treatment of TBF, however, is control over sepsis; otherwise, outcome of TBF is devastating.

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“… 6 The most common cause of acute mediastinitis is iatrogenic etiologies as a consequence of esophageal and cardiac surgery, tracheal intubation, and endoscopic procedures. 7 , 8 Occasionally, acute mediastinitis is caused by esophageal perforation or rupture of the tracheobronchial tree. 9 With the esophageal perforation, its bacterial flora can directly contaminate the mediastinum and result in infection.…”

Section: Mediastinitismentioning

confidence: 99%

“…Therefore, consultation with cardiothoracic surgeons is recommended. 6 , 7 Monitoring for resolution of fevers, leukocytosis, bacteremia, and presenting symptoms can help guide management and determine duration of antimicrobial therapy. If specific pathogens are isolated from blood cultures or drainage from mediastinal fluid collection, the antimicrobial therapy can be later modified and narrowed to target them.…”

Section: Managementmentioning

confidence: 99%

Esophageal Perforation and Acute Bacterial Mediastinitis

2015

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Esophageal perforation is a rare condition that is commonly missed. Male gender and alcohol use are predisposing risk factors. Most of the cases are iatrogenic or traumatic; nonetheless, spontaneous cases are not uncommon. It typically occurs after vomiting or straining as the increased intra-abdominal pressure transmits into the esophagus and results in the tear. One of the main complications is acute bacterial mediastinitis from contamination with esophageal flora. This condition can be life-threatening because it is very frequently misdiagnosed and appropriate management is often delayed.A 49-year-old man presented with worsening sudden-onset interscapular back pain that then changed to chest pain with odynophagia and was found to have fever and leukocytosis.Chest computed tomography revealed signs of mediastinitis with possible esophageal perforation. He reported symptoms started 2 days ago after lifting of heavy objects. Empiric antimicrobial was begun with conservative management and avoidance of oral intake. Barium esophagram and esophagogastroduodenoscopy revealed no signs of perforation or inflammation. His symptoms resolved and he gradually resumed oral intake. Blood cultures grew Methicillin-sensitive Staphylococcus aureus and he was discharged on appropriate antibiotics for 4 weeks. He did well on follow-up 3 months after hospitalization.The case highlights the importance of considering esophageal etiologies of chest pain.

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Acute mediastinitis: evaluation of clinical risk factors for death in surgically treated patients

Abstract: The knowledge of negative prognostic factors can appear to be a crucial tool enabling one to work out a better therapeutic strategy for high-risk patients with AM.

Cited by 12 publications

References 35 publications

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

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

Management of Nonmalignant Tracheo- and Bronchoesophageal Fistula after Esophagectomy

Esophageal Perforation and Acute Bacterial Mediastinitis

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