[20-year experience with diagnosis and treatment of different forms of purulent mediastinitis].

An experience of many years has shown that the most severe clinical course is observed in patients with mediastinitis due to injuries of the esophagus, and with odontogenous and tonsillogenous mediastinitis. Using the ultrasound method of investigation and computed tomography made the possibility to early diagnose this disease considerably wider. Treatment of patients with mediastinitis included surgical sanitation of the purulent focus, antibacterial, detoxicating and immune therapy, the central role being given to active drainage of the mediastinum with lavage and aspiration. In patients with mediastinitis resulting from rupture of the inferiorthoracic portion of the esophagus the isolation of the injured wall of the esophagus from the aggressive influence of gastric juice is an important measure. This problem can be solved by ligation of the abdominal part of the esophagus or by Nissen's fundoplication. Severe complications of mediastinitis such as empyema of the chest, purulent peritonitis and arrosive bleedings require active surgical strategy.