Fluoroscopically guided nose tube drainage of mediastinal abscesses in post-operative gastro-oesophageal anastomotic leakage

Abstract

Objective The aim of this study was to retrospectively evaluate the technical success rates and clinical effectiveness of fluoroscopically guided nose tube drainage of mediastinal abscesses and a nasojejunum feeding tube in post-operative gastro-oesophageal anastomotic leakage (GEAL). Methods From January 2006 to June 2011, 18 cases of post-operative GEAL with mediastinal abscesses after oesophagectomy with intrathoracic oesophagogastric anastomotic procedures for oesophageal and cardiac carcinoma were treated by insertion of a nose drainage tube and nasojejunum feeding tube under fluoroscopic guidance. We evaluated the feasibility of two-tube insertion to facilitate leakage site closure and complete resolution of the abscess, and the patients’ nutritional benefit was also evaluated by checking the serum albumin level between pre- and post-enteral feeding via the feeding tube. Results The two tubes were placed successfully under fluoroscopic guidance in 18 patients (100%). The procedure time for two-tube insertion ranged from 20 to 40 min (mean 30 min). 17 patients (94%) achieved leakage site closure after two-tube insertion and had a good tolerance of two tubes in the nasal cavity. The serum albumin level was significant, increased from pre-enteral feeding (2.49±0.42 g dl−1) to the post-enteral feeding (3.58±0.47 g dl−1) via the feeding tube (p<0.001). The duration of follow-up ranged from 1 to 49 months (mean 19 months). Conclusion The insertion of nose tube drainage and a nasojejunum feeding tube under fluoroscopic guidance is safe, and it provides effective relief from mediastinal abscesses in GEAL after oesophagectomy. Moreover, our findings indicate that two-tube insertion may be used as a selective procedure to treat mediastinal abscesses in post-operative GEAL. Advances in knowledge Directive drainage of mediastinal abscesses in post-operative GEAL may be an effective treatment.

One Decade of Experience with Endoscopic Stenting for Intrathoracic Anastomotic Leakage after Esophagectomy: Brilliant Breakthrough or Flash in the Pan?

“…Here endoscopic stent insertion, clipping, application of glue or plugs, endoscopically guided nose tube drainage of the mediastinal abscess as well as management by means of endoscopic vacuum-assisted closure system (E-VAC) were suggested. [32][33][34] However, the multitude of the proposed treatment options indicates the difficulty in realizing a definite solution. 35 During the last decade, endoscopic insertion of selfexpandable stents has gained wide acceptance as the treatment of choice to avoid surgical re-exploration.…”

Natural orifice endoscopic drainage of a perforated duodenal ulcer

“…In patients who are candidates for non-surgical treatment, spontaneous healing and a well-defined abscess cavity are associated with a favorable outcome [1]. In lieu of percutaneous drainage, natural orifice and naso-biliary drainage has been used to successfully manage abscesses associated with foregut perforations [1,4,5]. Choice of these techniques is influenced by body habitus along with the size and chronicity of the abscess cavity.…”

Acupuncture: a cause of mediastinal abscess presenting as axillary infection

“…Acute mediastinitis carries up to 40% mortality rate and is treated with intravenous broad spectrum antibiotics and various surgical drainage approaches including radical transcervical and transthoracic approaches . We highlight the need for a high index of suspicion in the assessment of any deep mediastinal abscess, especially in patients with recent haematoma with potential needle‐tracking of infection.…”

“…Other common causes include trauma, median sternotomy in cardiothoracic surgery and oesophageal perforation. A small proportion of mediastinal abscesses originate from infections in the anterior chest . Mediastinal abscesses are usually diagnosed on radiological imaging.…”