title: [Acute mediastinitis: clinical features and review of a case load].
abstract: The term acute mediastinitis describes a number of clinical conditions, usually secondary to diseases of other aetiology with which they tend to share the severity of the clinical picture. In these situations even a timely diagnosis and adequate therapeutic management are not always enough to ensure healing. Over the period 1987-2002 15 patients with acute mediastinitis were observed (8 male, 7 female), aged from 22 to 90 years (mean age: 57.9), distributed as follows: descending necrotising mediastinitis, 4 cases; iatrogenic oesophageal rupture, 2 cases; iatrogenic tracheal rupture, 3 cases; oesophageal perforation (foreign body), 4 cases; Boerhaave's syndrome, 1 case; oesophageal perforation (lye ingestion), 1 case. All patients except one--managed medically--were submitted to mediastinal drainage (surgical or by mediastinoscopy), combined with cervical debridement and drainage in cases of descending necrotising mediastinitis, alimentary tract diversion (cervical oesophagostomy + feeding jejunostomy + gastric decompression) in cases of large oesophageal lesions or if the lesion occurred more than 24 hours before observation, and uni- or bilateral tube thoracostomy. Furthermore, antibiotic therapy was always administered, initially choosing broad-spectrum medications, and subsequently adjusting according to bacterial cultures. Four patients died. In 4 cases (2 descending necrotising mediastinitis, 2 acute mediastinitis secondary to oesophageal perforation) repeated interventions were necessary in order to drain pleural or mediastinal effusions. Acute mediastinitis remains a serious clinical entity, the outlook of which is often poor. Factors influencing outcome are the patient's age and general condition (adequate immune response), a timely diagnosis, preoperative localisation of effusions, an aggressive therapeutic approach including drainage of infection sites in the mediastinum, neck and/or pleural cavities, alimentary tract diversion in cases of oesophageal lesions observed late, adequate antibiotic therapy, and nutritional support (total parenteral/enteral nutrition).
authors.affiliation: Struttura Complessa di Chirurgia Toracica, Università degli Studi di Perugia, Policlinico Monteluce, Via Brunamonti, 06100 Perugia.
authors.forename: Mark
authors.initials: M
authors.lastname: Ragusa
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
authors.forename: Costanzo
authors.initials: C
authors.lastname: Fedeli
authors.forename: Francesco
authors.initials: F
authors.lastname: Puma
authors.forename: Filippo
authors.initials: F
authors.lastname: Calzolari
authors.forename: Antonia
authors.initials: A
authors.lastname: Semeraro
authors.forename: Giuliano
authors.initials: G
authors.lastname: Daddi
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000601:surgery*; D008875:Middle Aged