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The Journal of Thoracic and Cardiovascular Surgery, Vol 91, 57-62, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Transesophageal irrigation for the treatment of mediastinitis produced by esophageal rupture

GH Santos and RW Frater

Esophageal rupture in the thorax, unless small and contained, is followed by the early onset of fulminant mediastinitis. When the rupture occurs in the cervical esophagus, mediastinitis will also occur if cervical drainage is delayed and the infection is allowed to spread along the periesophageal planes towards the mediastinum. The purpose of this article is to report the good results obtained in the treatment of life-threatening sepsis from esophageal rupture with the combination of continuous per oral transesophageal irrigation of the mediastinum and drainage of the irrigating fluid by accurately positioned chest tubes connected to a wall-suctioning system. When the patient cannot swallow, mediastinal irrigation is accomplished via a nasogastric tube positioned by the upper esophagus proximal to the perforation. Irrigation by mouth was also used for the treatment of cervical perforations with the drainage tubes positioned in the neck. With this method in eight patients, sepsis has invariably been controlled, and in six cases, in which no irreversible damage to the esophagus existed, the perforations have healed spontaneously. There was no death resulting from mediastinitis, which is most often the lethal factor in esophageal rupture.

This article has been cited by other articles:

				R. I. Whyte, M. D. Iannettoni, and M. B. Orringer Intrathoracic esophageal perforation: The merit of primary repair J. Thorac. Cardiovasc. Surg., January 1, 1995; 109(1): 140 - 146. [Abstract] [Full Text]

				G. H. Santos Late management of esophageal perforatio J. Thorac. Cardiovasc. Surg., August 1, 1994; 108(2): 392 - 393. [Full Text]