title: Acute mediastinitis associated with foreign body erosion from the hypopharynx and esophagus.
abstract: OBJECTIVE
  Mediastinitis secondary to hypopharyngeal and esophageal foreign bodies is a rare but lethal complication. So far, no literature on a large scale has been reported. This investigation reviewed cases of mediastinitis associated with foreign body ingestion during the past 40 years.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Second Xiangya Hospital, Central South University.
  
  
  METHODS
  Of 2981 patients with hypopharyngeal and esophageal foreign body impaction included between 1969 and 2010, 93 had complications of acute mediastinitis. Four patients were dead within 4 hours after admission. The rest of the 89 patients underwent surgical drainage. Thirteen underwent primary repair (7 cases with suture, 6 cases with omentum onlay graft), and 9 patients underwent endoscopic stent placement at the same time.
  
  
  RESULTS
  The mean (SD) time between ingestion and initial treatment of patients who developed mediastinitis was 7.72 (1.93) days, compared with 1.92 (1.41) days for those who did not (P < .05). Morbidity was 3.1% and mortality was 30.1% (28/93), but the mortality of every decade has decreased from 38.7% in the 1970s to 8.3% today. Nine cases with local stent were all recovered.
  
  
  CONCLUSIONS
  Delay in initiating treatment and intrathoracic esophageal foreign bodies are the main risk factors of mediastinitis secondary to foreign body ingestion. Computed tomography plays an important role in diagnosis and guiding treatments. In conjunction with aggressive surgical debridement and drainage, endoscopic stent placement could be the optimal management for most patients.
authors: Department of Otolaryngology-Head and Neck Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, PR China.
authors: Jiajia
authors: J
authors: Liu
authors: Xiaoli
authors: X
authors: Zhang
authors: Dinghua
authors: D
authors: Xie
authors: Anquan
authors: A
authors: Peng
authors: Xinming
authors: X
authors: Yang
authors: Fenglei
authors: F
authors: Yu
authors: Deliang
authors: D
authors: Liu
mesh_terms: D000208:Acute Disease; D003937:Diagnosis, Differential; D004322:Drainage / Q000379:methods*; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus; D005547:Foreign Bodies / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007013:Hypopharynx; D008480:Mediastinitis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011379:Prognosis; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices