Slovenská chirurgia 3 - 4/2021

Mediastinitis: recent experiences from our clinic

Mediastinitis is defined as severe, devastating inflammation of the connective tissues and structures within the mediastinum. Incidence ranges between 2.5-5% but mortality remains still high 10-49%. Different types of mediastinitis can be classified: deep sternal wound infection (DSWI), mediastinitis after gastrointestinal perforation, descending necrotizing mediastinitis and finally chronic fibrosing mediastinitis, which is very rare and usually associated with autoimmune abnormalities and tuberculosis or histoplasmosis infection. Time interval between first symptoms and final diagnosis is extremely important as delay in diagnosis has a high impact on overall mortality. Contrast-enhanced computed tomography (CT)-scan (with additional oral contrast if an oesophageal lesion is suspected) is the diagnostic tool of choice in the diagnosis of mediastinitis. Treatment requires surgical emergency and is managed in specialized centers. Patients hospitalized in 2nd clinic of surgery L. Pasteur University hospital and P. J. Šafárik University, Medical faculty, with diagnose of mediastinitis during period of years 2012-2019 (8 years) are described in our recent study. Observe, retrospective, descriptive study was use. 47 patients with mediastinitis were treated in this period. Mortality was 31.9%. DNM was diagnosed in 23 patients and perforation of GIT in 24 patients.

Keywords: mediastinitis, oropharyngeal infection, gastrointestinal perforation, toracotomy