<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_jccm-2019-0008_s_009_w2aab2b8c26b1b7b1aab1c16b1Aa"><h3>Background</h3><p>Despite recent advancements in antibiotic therapy and the progress made in critical care and modern diagnostic methods, acute mediastinitis continues to be a severe condition.</p></sec><sec id="j_jccm-2019-0008_s_010_w2aab2b8c26b1b7b1aab1c16b2Aa"><h3>Diagnosis and treatment</h3><p>Acute mediastinitis can occur in the context of cardio-thoracic surgery, oesophageal perforations and oropharyngeal infections condition. Forty-five percent of oesophageal perforations occurs during simple endoscopy. Spontaneous perforation (Boerhaave syndrome) accounts for 15% of perforations, and twelve percent are due to the ingestion of foreign bodies. Other causes include blind or penetrating trauma, and circa 9% to intraoperative lesions. CT scan is the standard investigation that reveals direct signs of mediastinitis.</p><p>The oral administration of contrast substances can underscore the level of oesophageal perforation. Conservative treatment is the first-choice treatment and surgical treatment is reserved only for specific situations.</p><p>The principles of surgical treatment consist of drainage, primary suture, oesophageal exclusion with or without the application of oesophagectomy, endoscopic vacuum wound assisted therapy of the perforation and associated paraoesophageal mediastinal drainage and endoscopic stenting associated with drainage.</p></sec><sec id="j_jccm-2019-0008_s_011_w2aab2b8c26b1b7b1aab1c16b3Aa"><h3>Conclusions</h3><p>The lowest mortality rate is recorded in patients with perforations diagnosed less than twenty-four hours after the onset of symptoms. Surgical treatment remains the gold standard especially in cases of thoracic and abdominal perforations while further investigations are mandatory before endoscopic stenting is carried out.</p></sec></abstract>

BackgroundDespite recent advancements in antibiotic therapy and the progress made in critical care and modern diagnostic methods, acute mediastinitis continues to be a severe condition.Diagnosis and treatmentAcute mediastinitis can occur in the context of cardio-thoracic surgery, oesophageal perforations and oropharyngeal infections condition. Forty-five percent of oesophageal perforations occurs during simple endoscopy. Spontaneous perforation (Boerhaave syndrome) accounts for 15% of perforations, and twelve percent are due to the ingestion of foreign bodies. Other causes include blind or penetrating trauma, and circa 9% to intraoperative lesions. CT scan is the standard investigation that reveals direct signs of mediastinitis.The oral administration of contrast substances can underscore the level of oesophageal perforation. Conservative treatment is the first-choice treatment and surgical treatment is reserved only for specific situations.The principles of surgical treatment consist of drainage, primary suture, oesophageal exclusion with or without the application of oesophagectomy, endoscopic vacuum wound assisted therapy of the perforation and associated paraoesophageal mediastinal drainage and endoscopic stenting associated with drainage.ConclusionsThe lowest mortality rate is recorded in patients with perforations diagnosed less than twenty-four hours after the onset of symptoms. Surgical treatment remains the gold standard especially in cases of thoracic and abdominal perforations while further investigations are mandatory before endoscopic stenting is carried out.

Sepsis in Acute Mediastinitis – A Severe Complication after Oesophageal Perforations. A Review of the Literature

The Journal of Critical Care Medicine

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

BackgroundDespite recent advancements in antibiotic therapy and the progress made in critical care and modern diagnostic methods, acute mediastinitis continues...

Sepsis in Acute Mediastinitis – A Severe Complication after Oesophageal Perforations. A Review of the Literature

Article Category: Review

Published Online: May 13, 2019

Page range: 49 - 55

Received: Mar 12, 2019

Accepted: Apr 23, 2019

DOI: https://doi.org/10.2478/jccm-2019-0008

Keywords
Acute mediastinitis, oesophageal perforation, Boerhaave syndrome

© 2019 Mircea Mureșan, Simona Mureșan, Ioan Balmoș, Daniela Sala, Bogdan Suciu, Arpad Torok, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Sepsis in Acute Mediastinitis – A Severe Complication after Oesophageal Perforations. A Review of the Literature

Article Category: Review

Published Online: May 13, 2019

Page range: 49 - 55

Received: Mar 12, 2019

Accepted: Apr 23, 2019

DOI: https://doi.org/10.2478/jccm-2019-0008

KeywordsAcute mediastinitis, oesophageal perforation, Boerhaave syndrome

© 2019 Mircea Mureșan, Simona Mureșan, Ioan Balmoș, Daniela Sala, Bogdan Suciu, Arpad Torok, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Keywords
Acute mediastinitis, oesophageal perforation, Boerhaave syndrome