L Lundell1, B Liedman, A Hyltander. 1. Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden. lars.lundell@surgery.gu.se
Abstract
OBJECTIVE: To evaluate an aggressive surgical strategy in patients with mediastinal sepsis as a result of oesophageal leakage. DESIGN: A prospective clinical study. SETTING: University hospital, Sweden. SUBJECTS: 11 consecutive patients who presented with mediastinal sepsis as a result of a damaged oesophagus caused by instrumental perforation in 4 cases and spontaneous rupture in 6 cases during a 6-year period. INTERVENTIONS: Ten patients were treated with oesophagectomy with a diverting proximal oesophagostomy and in one case a primary cervical oesophagogastrostomy was done after emergency resection. MAIN OUTCOME MEASURES: Mortality and morbidity. RESULTS: The median delay from onset of symptoms to admission to the unit was 3 days (range 0-6). All patients required artificial ventilation postoperatively and the stay in the ICU amounted to 12.5 days but only 1 patient died during the postoperative course. All patients have subsequently undergone substernal oesophageal replacement with either a gastric tube or a colonic graft. CONCLUSION: Emergency oesophagectomy and proximal deviating oesophagostomy is a salvage procedure for patients with severe fulminant mediastinal sepsis, and it can be done in selected cases with good results.
OBJECTIVE: To evaluate an aggressive surgical strategy in patients with mediastinal sepsis as a result of oesophageal leakage. DESIGN: A prospective clinical study. SETTING: University hospital, Sweden. SUBJECTS: 11 consecutive patients who presented with mediastinal sepsis as a result of a damaged oesophagus caused by instrumental perforation in 4 cases and spontaneous rupture in 6 cases during a 6-year period. INTERVENTIONS: Ten patients were treated with oesophagectomy with a diverting proximal oesophagostomy and in one case a primary cervical oesophagogastrostomy was done after emergency resection. MAIN OUTCOME MEASURES: Mortality and morbidity. RESULTS: The median delay from onset of symptoms to admission to the unit was 3 days (range 0-6). All patients required artificial ventilation postoperatively and the stay in the ICU amounted to 12.5 days but only 1 patient died during the postoperative course. All patients have subsequently undergone substernal oesophageal replacement with either a gastric tube or a colonic graft. CONCLUSION: Emergency oesophagectomy and proximal deviating oesophagostomy is a salvage procedure for patients with severe fulminant mediastinal sepsis, and it can be done in selected cases with good results.
Authors: Andrej Udelnow; Markus Huber-Lang; Markus Juchems; Karl Träger; Doris Henne-Bruns; Peter Würl Journal: World J Surg Date: 2009-04 Impact factor: 3.352
Authors: Michael Hermansson; Jan Johansson; Tomas Gudbjartsson; Göran Hambreus; Per Jönsson; Ramon Lillo-Gil; Ulrika Smedh; Thomas Zilling Journal: BMC Surg Date: 2010-10-28 Impact factor: 2.102