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
