Mediastinitis without antecedent cardiac surgery

Roy Thomas Temes, R. E. Crowell, D. W. Mapel, F. Follis, S. B. Pett, J. A. Wernly

Research output: Contribution to journalArticle

Abstract

Purpose: Review the etiology and results of aggressive transthoracic surgical treatment of mediastinitis from non-cardiac surgical causes. Methods: A retrospective review of mediastinitis from any cause other than cardiac surgery treated at the University of New Mexico, the Albuquerque VA Medical Center, and the Lovelace Medical Center between June 1, 1992 and May 31, 1996. Patients with deep cervical infections superior to the thoracic inlet are excluded. Results: There were 8 patients. Seven were male, 1 was female. Median age was 60 years (range 31 to 84 years). The etiology was Boerhaave's syndrome in 3, iatrogenic in 2 (esophageal intubation and neck injections, 1 each), anastomotic leak following esophagectomy in 1, and necrotizing mediastinitis of unknown cause in 2 patients. The median number of operations was 2.5 (range 1-6). The initial operation was through a thoracotomy in 5 patients and a sternotomy in 2 patients. Four patients underwent drainage through the neck; 1 as primary drainage and 3 combined with transthoracic drainage. Median hospitalization was 45 days (range 3 to 95 days). Complications included mechanical ventilation greater than 48 hours in 88% (7/8), 2 or more operations in 63% (5/8), multi system organ failure in 63% (5/8) and other complications in 75% (6/8). Death occurred in 25% of patients (2/8). Conclusions: Mediastinitis from noncardiac etiologies occurs infrequently. It is associated with significant morbidity, however with aggressive transthoracic drainage 75% of patients survive. Clinical Implications: Aggressive transthoracic drainage of mediastinitis from non-cardiac surgery causes is the treatment of choice and results in high survival rates.

Original languageEnglish
JournalChest
Volume110
Issue number4 SUPPL.
Publication statusPublished - Oct 1996

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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