title: Emergency oesophagectomy and proximal deviating oesophagostomy for fulminent mediastinal sepsis.
abstract: 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.
authors.affiliation: Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden. lars.lundell@surgery.gu.se
authors.forename: L
authors.initials: L
authors.lastname: Lundell
authors.forename: B
authors.initials: B
authors.lastname: Liedman
authors.forename: A
authors.initials: A
authors.lastname: Hyltander
mesh_terms: 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