[Surgical treatment of life-threatening mediastinitis following esophageal perforation or leakage after esophagus surgery].

OBJECTIVE

Evaluation of the surgical treatment of life-threatening mediastinitis following oesophageal perforation or leakage after resection for oesophageal cancer.

DESIGN

Descriptive retrospective.

SETTING

Department of Surgery, University Hospital Utrecht.

METHODS

Between June 1989 and October 1994, 18 patients with severe mediastinitis and sepsis following perforation of the oesophagus or leakage after oesophageal resection for oesophageal cancer were treated with aggressive surgery. (Peri-)anastomotic leakage was the cause of mediastinitis and sepsis in 14 patients, 3 patients perforated during endoscopy and 1 patient suffered a spontaneous perforation. Aggressive surgery consisted of removing the oesophageal replacement from the mediastinum, creating an oesophago-cutaneostomy and a feeding enterostomy and drainage of the mediastinum and interpleural spaces.

RESULTS

All patients survived; however, postoperative morbidity was high. The alimentary tract was reconstructed in 15 patients.

CONCLUSION

Aggressive surgical treatment of life-threatening mediastinitis and sepsis as described here can save severely ill patients. Because of the high postoperative morbidity level only patients with perforations of the oesophagus and early stages of oesophageal cancer should be operated.