Surgical treatment of patients, suffering esophageal perforation, complicated by an acute purulent mediastinitis

Keywords: esophageal perforation; mediastinitis; treatment of esophageal perforation

Abstract

Objective. To improve the treatment results in patients with esophageal perforation (EP), complicated by an acute purulent mediastinitis (APM).

Маterials and methods. Through 2004 - 2018 yrs in the Department of Thoracic Surgery of the Іvano-Frankivsk Regional Clinical Hospital 30 patients with EP, complicated by an APM, were operated. The patients have aged 21 - 76 yrs old, and at average - (36.3 ± 3.9) yrs. There were 21 (70%) men and 9 (30%) women.

Results. Іntramediastinal injection of antibacterial preparations and irrigation of esophageal sutures have promoted a rapid elimination of purulent-inflammatory process in mediastinum. In 6 (37.5%) patients a completely hermetic sutures of the esophageal perforation site were registered, while reduction of the esophageal defect size - in 9 (56.2%) of 16 patients.

Conclusion. EP must be sutured for bordering of esophageal lumen from the mediastinal cellular tissue, the mediastinal purulent process restriction and stabilization of the patient’ general condition. Міniinvasive operative interventions, using video-assisted thoracoscopy, may serve the procedures of choice in patients with EP and extended APM for sanation and drainage of purulent-inflammatory foci in mediastinum, the patients’ state stabilization and prevention of the septic complications development. Іntramediastinal injection of antibacterial preparations and irrigation of esophageal sutures have improved the treatment results and promoted the endogenous intoxication lowering, the EP healing acceleration and to eliminate a purulent mediastinitis.

Author Biographies

I. M. Shevchuk, Ivano-Frankivsk National Medical University

Ihor M. Shevchuk, MD, Doctor Sci (Med), Professor,

Head of the Department of Surgery No. 2 and Cardiac Surgery.

Ivano-Frankivsk National Medical University,

2 Galitska str, 76018, Ivano-Frankivsk, Ukraine.

+380503732908

snizhko.s@bigmir.net

S. S. Snizhko, Ivano-Frankivsk National Medical University

Sergey S. Snizhko, MD, PhD (Med), Associate Professor,

Department of Surgery No. 2 and Cardiac Surgery.

Ivano-Frankivsk national medical university.

2 Galickaya str., 76018, Ivano-Frankivsk, Ukraine,

tel.: +380506102172

E-mail: snizhko.s@bigmir.net

ORCID: http://orcid.org/0000-0001-5418-7825

S. A. Andreieshchev, Shupyk National Medical Academy of Postgraduate Education, Kyiv

Sergey A. Andreieshchev, MD, PhD, Associate professor,
Associate professor Department of Surgery and Transplantology, 
Shupyk National Medical Academy of Postgraduate Education. 
30 Heroiv Sevastopolia Str., 03680, Kyiv, Ukraina,

+38 (044) 408-18-11
info@hirurgiya.com.ua 

http://orcid.org/0000-0002-2281-1803

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Published
2018-11-01
How to Cite
Shevchuk, I. M., Snizhko, S. S., & Andreieshchev, S. A. (2018). Surgical treatment of patients, suffering esophageal perforation, complicated by an acute purulent mediastinitis. Klinicheskaia Khirurgiia, 85(11), 13-17. https://doi.org/10.26779/2522-1396.2018.11.13
Section
General Problems of Surgery