Emergency oesophagectomy and proximal deviating oesophagostomy for fulminent mediastinal sepsis.
OBJECTIVE
To evaluate an aggressive surgical strategy in patients with mediastinal sepsis as a result of oesophageal leakage.


METHODS
A prospective clinical study.


METHODS
University hospital, Sweden.


METHODS
11 consecutive patients who presented with mediastinal sepsis as a result of a damaged oesophagus caused by instrumental perforation in 4 cases and spontaneous rupture in 6 cases during a 6-year period.


METHODS
Ten patients were treated with oesophagectomy with a diverting proximal oesophagostomy and in one case a primary cervical oesophagogastrostomy was done after emergency resection.


METHODS
Mortality and morbidity.


RESULTS
The median delay from onset of symptoms to admission to the unit was 3 days (range 0-6). All patients required artificial ventilation postoperatively and the stay in the ICU amounted to 12.5 days but only 1 patient died during the postoperative course. All patients have subsequently undergone substernal oesophageal replacement with either a gastric tube or a colonic graft.


CONCLUSIONS
Emergency oesophagectomy and proximal deviating oesophagostomy is a salvage procedure for patients with severe fulminant mediastinal sepsis, and it can be done in selected cases with good results.
Lundell
L
L
Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden. lars.lundell@surgery.gu.se
Liedman
B
B
Hyltander
A
A
D018806:APACHE; D000368:Aged; D004630:Emergencies; D004939:Esophageal Perforation / Q000150:complications*; D016629:Esophagectomy / Q000379:methods*; D004946:Esophagostomy / Q000379:methods*; D005260:Female; D005774:Gastrostomy; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000209:etiology / Q000601:surgery*; D013548:Sweden; D016896:Treatment Outcome