Surgical treatment of descendent purulent mediastinitis


Keywords: descendent purulent mediastinitis; surgical treatment of mediastinitis; іntramediastinal application of antibiotics

Abstract

Objective. To improve the results of treatment in patients, suffering descendent purulent mediastinitis (DPM), using improved surgical accesses to mediastinum as well as the methods of local surgical treatment and draining of mediastinum.

Маterials and methods. Examination and treatment of 170 patients, suffering the neck phlegmon (NPH) in 2004 - 2018 yrs, were conducted. In 73 (42.9%) patients the NPH was complicated by DPM. There were 49 (67.1%) men and 24 (32.9%) women, ageing 21-72 yrs old, while average age have constituted (47.3 ± 4.3) yrs old.

Results. Surgical treatment of DPM is directed towards elimination of the disease primary focus, choice of operative access to mediastinum, opening and sanation of all mediastinal purulent foci, guaranteeing constant evacuation of purulent material from mediastinal cellular space and pleural cavity. While the іntramediastinal antibiotics application in 30 (90.9%) of 33 patients a purulent process was eliminated in the NPH stage of the disease without its spreading into cellular mediastinum. DPM have been developed in 3 (9.1%) patients only. Of 137 patients, in whom the method was not applied, in 70 (51.1%) a NPH was complicated by DPM.

Conclusion. While іntramediastinal antibiotics application in patients, suffering  NPH, we have lowered the purulent process spreading in mediastinum with DPM development from 51.1 tо 9.1%. Lesser traumaticity, the operation duration reduction, good visualization of the pleural portions affected and possibility of accomplishment of miniinvasive drainage of mediastinum and pleural cavity constitute the advantages of application of videoassisted thoracoscopy in comparison with thoracotomy.

The surgical treatment tactics, elaborated for DPM guarantees an adequate sanation of purulent foci in the neck and mediastinum, rapid lowering of the endogenous intoxication level and lethality reduction from 27.0 tо 8.3%.

References

1. Аbакumov ММ, Pogodina AN, Barmina TG. 20 years of expiriense of diagnostic and treatment of different forms of purulent mediastinitis. Vestnik Hirurgiyi. 2001;(1):80-5.

2. Shipulin PP. Treatment of acute purulent mediastinitis. Hirurgiya. 2001;(8):58-61.

3. Hofmann HS. Mediastinitis. Chirurg. 2016 Jun;87(6):467-8. http://doi.org/10.1007/s00104-016-0204-3.

4. Kluge J. Acute and chronic mediastinitis. Chirurg. 2016 Jun;87(6):469-77. http://doi.org/10.1007/s00104-016-0172-7.

5. Kang SK, Lee S, Oh HK, Kang MW, Na MH, Yu JH, et al. Clinical features of deep neck infections and predisposing factors for mediastinal extension. Korean J Thorac Cardiovasc Surg. 2012 June;45(3):171–6. http://doi.org/10.5090/kjtcs.2012.45.3.171.

6. Kruger M, Decker S, Schneider А, Haverich A, Schega O. Surgical treatment of acute mediastinitis. Chirurg. 2016 Jun; 87(6):478-85. http://doi.org/10.1007/s00104-016-0171-8.

7. Elsahy TG, Alotair HA, Alzeer AH, Al-Nassar SA. Descending necrotizing mediastinitis. Saudi Med J.2014 Sep.35(9):1123–6. PMID: 25228187.

8. Bayarri Lara CI, Sevilla Lopez S, Sanchez-Palencia Ramos A, Alkourdi Martinez A, Hernandez Escobar F, Quero Valenzuela F, et al. Surgical management of descending necrotizing mediastinitis. Cir Esp. 2013 Nov;91(9):579–83. http://doi.org/10.1016/j.ciresp.2012.11.012.

9. D’Cunha J, James M, Antonoff MB, Gree CA, Andrade RS, Maddaus MA, et al. Descending necrotizing mediastinitis: a modified algorithmic approach to define a new standard of care. Surg Infect (Larchmt). 2013 Dec;14(6):525–31. http://doi.org/10.1089/sur.2012.079.

10. Hsin MK, Yim AP. Video assisted thoracoscopic surgery is a valuable approach for the management of descending necrotizing mediastinitis. Ann Surg. 2011 May.253(5):1055–6. http://doi.org/10.1097/SLA.0b013e3182172e6b.

Author Biographies


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

Shevchuk Ihor M., MD, DSci (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


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

Snizhko Sergiy S., MD., PhD., Associate Professor,
Department of Surgery No. 2 and Cardio Surgery,
Ivano-Frankivsk National Medical University, Ivano-Frankivsk city.
+380506102172
snizhko.s@bigmir.net
https://orcid.org/0000-0001-5418-7825


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

Andreieshchev Sergey A., 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) 4081811
info@hirurgiya.com.ua
http://orcid.org/0000-0002-2281-1803

Published
2019-02-27
How to Cite
Shevchuk, I. M., Snizhko, S. S., & Andreieshchev, S. A. (2019). Surgical treatment of descendent purulent mediastinitis. Klinicheskaia Khirurgiia, 86(2), 3-8. https://doi.org/10.26779/2522-1396.2019.02.03
Section
General Problems of Surgery