Related Experiment Videos
Surgical treatment of acute purulent mediastinitis
A Cherveniakov1, P Cherveniakov
1Emergency Medical Institute N. I. Pirogov, Sofia, Bulgaria.
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.
Insights
Acute purulent mediastinitis (APM) treatment involved 147 patients over 15 years. Surgical intervention and antibiotics were key, with a 14.3% mortality rate, primarily from broncho-pneumonia and shock.
Area of Science:
- Thoracic Surgery
- Infectious Diseases
- Gastroenterology
Background:
- Acute purulent mediastinitis (APM) is a severe infection with high morbidity.
- Oesophageal and non-oesophageal origins represent distinct etiological categories.
- Timely diagnosis remains a challenge, with early identification occurring in only 43.5% of cases.
Purpose of the Study:
- To analyze treatment outcomes for acute purulent mediastinitis (APM) over a 15-year period.
- To categorize APM cases by etiology and evaluate therapeutic strategies.
- To identify factors influencing mortality in APM patients.
Main Methods:
- Retrospective analysis of 147 patients with APM treated over 15 years.
- Classification of patients into oesophageal and non-oesophageal origin groups.
- Review of therapeutic interventions including antibiotics, immunotherapy, surgical drainage, oesophageal repair, and oesophagectomy with colon transplant.
Main Results:
- 112 cases originated from oesophageal causes, while 35 were non-oesophageal.
- Therapeutic approaches included mediastinal drainage (86 patients) and oesophagectomy with colon transplant (61 patients).
- Overall mortality was 14.3% (21 patients), with common causes being broncho-pneumonia, endotoxic shock, and renal failure.
Conclusions:
- Effective management of APM requires a multimodal approach including surgical intervention and supportive care.
- Oesophageal origin is the predominant etiology for APM in this cohort.
- Despite advances, APM continues to present significant challenges, necessitating improved diagnostic and therapeutic strategies to reduce mortality.