Features of surgical treatment of esophageal injuries complicated by purulent mediastinitis

Authors

DOI:

https://doi.org/10.26641/2307-0404.2020.3.214850

Keywords:

esophageal perforation, purulent mediastinitis, surgical tactics

Abstract

The goal of the work is to improve the results of treatment of patients with esophageal perforations complicated by purulent mediastinitis. Examination and treatment of 30 patients with esophageal perforation (EP) complicated by purulent mediastinitis were performed. The causes of EP were foreign body damages in 12 (40%) of 30 patients, spontaneous rupture of the esophagus – in 11 (36.6%), iatrogenic damage to the esophagus – in 7 (23.4%) patients. The main method of surgical treatment of esophageal perforations complicated by acute purulent mediastinitis is thoracotomy with suturing of the perforated wall of the esophagus and sanation of mediastinal tissue. In case of purulent melting of the esophageal wall and total mediastinitis with severe endogenous intoxication, surgical interventions should be aimed at minimizing surgical trauma and elimination of the purulent process in the mediastinum using video-assisted thoracoscopy. The use of developed surgical tactics for the treatment of esophageal perforations complicated by acute purulent mediastinitis with intramediastinal administration of antibacterial drugs and the method of irrigation of the esophageal sutures contributes to a significant rapid reduction in endogenous intoxication, namely leukocytosis units up to 2.103±0.182 d. units (p<0,001) with normalization of the indicator on the 5th day from the beginning of treatment, the severity of the condition on the APACHE II scale in the modification of Radzikhovsky AP from 14.91±1.80 points at the time of hospitalization to 9.4±0.3 points on the second day after surgery (p<0.001), the severity of patients’ condition on the SOFA scale on the 3rd day to 3.221±0.445 points, on the 5th day – 1.832±0.219 points (p<0.001), the level of C-reactive protein on the 2nd day after surgery decreased from 236.2±21.4 mg/l to 144.3±9.3 mg/l, and on the 3rd day was 112.1±7.2 mg/l (in both cases p<0.001), reducing the content of procaltcytonin from 8.7±0.9 ng/ml to 3.828±0.251 ng/ml on the 2nd day after surgery. The use of this surgical tactic allows you to quickly eliminate the purulent process in the mediastinum, reduce the healing time of the perforation of the esophagus and reduce mortality from 28.5 to 6.2%.

Author Biographies

I. M. Shevchuk

Ivano-Frankivsk National Medical University
Department of Surgery N 2 and Cardiac Surgery
Halytska str., 2, Ivano-Frankivsk, 76000, Ukraine

S. S. Snizhko

Ivano-Frankivsk National Medical University
Department of Surgery N 2 and Cardiac Surgery
Halytska str., 2, Ivano-Frankivsk, 76000, Ukraine

References

Ivchenko GI, Vtlvedev YuI. Introduction to mathematical statistics. Moscow: publishing house LCI; 2010. p. 600. Russian.

Snizhko SS. [Analysis of the results of treatment of patients with esophageal injuries complicated by acute purulent mediastinitis]. Art of medicine. 2018;4(8):158-62. Ukrainian.

Shevchuk IM, Snizhko SS, Andreyeshchev SA. [Surgical treatment of patients with esophageal perfo­ration complicated by acute purulent mediastinitis]. Clinical surgery. 2018;85(11):13-17. Ukrainian.

Mircea Chirica, Michael D Kelly, StefanoSiboni, Alberto Aiolfi, Carlo Galdino Riva, Emanuele Asti. Esophageal Emergencies: WSES Guide-lines World J Emerg Surg. 2019 May 31;14:26. doi: https://doi.org/10.1186/s13017-019-0245-2

Mustafa Kupeli, Abdullah Dogan. SuccessfulTreatment of a Late Diagnosed Esophageal Perforation With Mediastinitis and Pericardial Abscess. J Coll Physicians Surg Pak. 2018 Dec;28(12):972-3. doi: https://doi.org/10.29271/jcpsp.2018.12.972

Markar SR, Mackenzie H, Wiggins T, Askari A,Faiz O, Zaninotto G, Hanna GB. Management and Outco-mes of Esophageal Perforation: A National Study of 2,564 Patients in England. Am J Gastroenterol. 2015 Nov;110(11):1559-66. doi: https://doi.org/10.1038/ajg.2015.304

Sasha Still, Marissa Mencio, Estrellita Ontiveros,James Burdick,Steven G Leeds. Primary and Rescue Endoluminal Vacuum Therapy in the Management of Esophageal Perforations and Leaks. Ann Thorac Cardio-vasc Surg. 2018 Aug 20;24(4):173-9. doi: https://doi.org/10.5761/atcs.oa.17-00107

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

Pezzetta E, Kokudo T, Uldry E, Yamaguchi T,et al. The surgical management of spontaneousesopha-geal perforation (Boerhaave’s syndrome) ‒ 20 years of experience. Biosci Trends. 2016 May 23;10(2):120-4. Russian. doi: https://doi.org/10.5582/bst.2016.01009

Singer M, Deutschman CS, Warren Seymour C,Manu Shankar-Hari, Djillali Annane, Bauer M, et al. "The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)". JAMA. 2016;315(8):801-10. https://doi.org/10.1001/jama.2016.0287

Vest Michael T, Dross Peter. Boerhaave Syndrome. J Am Osteopath Assoc. 2018 Nov 1;118(11):764. doi: https://doi.org/10.7556/jaoa.2018.165

Published

2020-10-05

How to Cite

1.
Shevchuk IM, Snizhko SS. Features of surgical treatment of esophageal injuries complicated by purulent mediastinitis. Med. perspekt. [Internet]. 2020Oct.5 [cited 2024Dec.11];25(3):132-9. Available from: https://journals.uran.ua/index.php/2307-0404/article/view/214850

Issue

Section

CLINICAL MEDICINE