Features of surgical treatment of primary acute purular mediastinitis

Abstract

Background. Diagnosis and treatment of purulent mediastinitis is determined by the severity of the disease, the lack of uniform criteria for surgical tactics, a large number of purulent complications and high mortality. The purpose of the study is to analyze the results of diagnosis and treatment of primary acute purulent mediastinitis of various etiologies to improve the quality of treatment. Materials and methods. The results of treatment of 133 patients with primary acute purulent mediastinitis are presented. All patients underwent surgery. Results. Among the causes of primary acute purulent mediastinitis, spontaneous ruptures of the esophagus are in first place (42.1 %), damage to the esophagus by a foreign body is in second place (21.8 %), and iatrogenic damage to the esophagus is in third place (19.5 %). Satisfactory treatment results were obtained in 105 patients (78.9 %), death occurred in 28 (21.1 %). The main causes of death were disease progression and erosive bleeding. Conclusions. The main causes of primary acute purulent mediastinitis are spontaneous ruptures of the esophagus and its damage by a foreign body. The mortality rate depends on the timing of patients’ admission to the hospital, the adequacy of surgical intervention and the extent of the purulent process in the mediastinum.

Keywords

• purulent mediastinitis
• esophageal rupture
• perforation
• iatrogenic damage