Analysis of treatment outcomes of patients with perforations of the esophagus, complicated by acute purulent mediastinitis
DOI:
https://doi.org/10.11603/2414-4533.2018.2.9188Keywords:
perforation of the esophagus, acute purulent mediastinitis.Abstract
The aim of the work: improving the treatment outcome of patients with perforation of the esophagus, which is complicated by acute purulent mediastinitis.
Materials and Methods. The results of treatment of 27 patients were analyzed.
Results and Discussion. The causes of perforation of the esophagus were foreign bodies in 9 (33.3 %), spontaneous rupture – in 8 (29.6 %), iatrogenic – in 5 (18.5 %), failure of sutures after resection of the esophagus and stenting – in 5 (18.5%). Postoperative lethality in patients with perforation of the esophagus complicated by acute purulent mediastinitis was 37.1 % (10 among 27 patients died). In the application of lateral thoracotomy, postoperative lethality was 50 % (9 among 18 patients died), with video-assisted thoracoscopy 14.3 % (1 among 7 patients died).
Timely diagnosis of perforation of the esophagus and acute purulent mediastinitis is one of the decisive factors in the treatment of these patients. The choice of surgical tactics should be individual in each individual case. The main purpose of surgical treatment is to eliminate the purulent-inflammatory process in the mediastinum and stabilize the condition of the patients. With perforation of the esophagus, which is complicated by acute purulent mediastinitis, expanded operations in the esophagus are accompanied by high rates of postoperative lethality, which limits their use in patients with sepsis and multiple organ failure. Stitching of the perforation of the esophagus should be performed to distinguish the esophageal lumen from the mediastinal fluid, localization of the purulent process in the mediastinum, and to stabilize the general condition of the patient. Minimal invasive surgical interventions using video-assisted thoracoscopy can serve as a selection option in patients with perforation of the esophagus in the common forms of acute purulent mediastinitis for the sanation and drainage of the purulent-inflammatory process in the mediastinum, stabilization of the patient's condition and prevention of septic complications.
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