[Mediastinitis after esophageal perforation].

INTRODUCTION

Assessment of therapy in patients with mediastinal infection resulting from esophageal perforation.

MATERIAL AND METHODS

Retrospective (2008-2012) processing of a group of surgically treated patients. The aspects assessed were aetiology, the surgical methods applied and the length of therapy.

RESULTS

The total number of patients treated was 16. In 8 cases, the aetiology was iatrogenic (3 cases of leaking esophageal anastomosis in consequence of resection of the esophagus, 2 cases of perforation after fundoplication, 1 case of esophageal cardiomyotomy, and 2 cases of perforation during endoscopy). In 4 patients, the aetiology was spontaneous perforation, impacted foreign bodies caused difficulties to 3 patients, and the last cause was acid corrosive esophagitis. A stent was applied in all the patients at the site of the defect. The mediastinitis was drained through the access from thoracotomy or left thoracolaparotomy, respectively (8 cases), or by combination of laparotomy/laparostomy and pleural drainage (5 cases). Pleural (in 3 cases) and neck (1 case) drainage meant minimum intervention. Esophagectomy was not carried out in any of the patients. 4 patients died. The average period of time for which the stent was left in situ was 53.7 days; the average time of hospitalization in surviving patients was 53.4 days.

CONCLUSION

Stent application does not show any difference regarding patients' survival (25% mortality), but enables shortening the total therapy time and, predominantly, preserving the native esophagus.