Mediastinitis Without Antecedent Surgery

Abstract

The study evaluates the results of aggressive surgical treatment for mediastinitis without antecedent surgery, after retrospectively reviewing all patients with mediastinitis, excluding patients with prior cardiac, esophageal or mediastinal Operations, treated between June 1, 1992 and August 1, 1996. 8 patients were treated. 7 were male, mean age was 58 years. The etiology was Boerhaave's Syndrome in 4, iatrogenic injury in 2 and descending necrotizing mediastinitis in 2 patients. The mean number of Operations was 2.5. The initial Operation was through thoracotomy in 5 patients and sternotomy in 2 patients. 4 patients underwent neck drainage, 1 as primary treatment and 3 combined with transthoracic drainage. 1 patient received laparotomy. Mean hospitalization was 52 days (excluding 1 death). Complications included mechanical Ventilation greater than 48 hours in 7 patients, 2 or more Operations in 5 patients, multisystem organ failure in 5 patients and other complications in 6 patients. Death occurred in one patient. Mediastinitis without antecedent surgery is associated with significant morbidity, however, with aggressive surgical drainage 87% of patients survived.

Key words

Mediastinitis - Boerhaave - Descending necrotizing mediastinitis