DIAGNOSIS AND TREATMENT OUTCOMES OF ACUTE MEDIASTINITIS FOLLOWING THORACIC ESOPHAGEAL INJURY

Authors:

Abstract:

Retrospective study included 47 consecutive patients (20 men and 27 women) aged 32–59 years who were treated for acute mediastinitis secondary to open and closed injuries of the thoracic esophagus at the Department of General Surgery in Azerbaijan Medical University (Baku, Azerbaijan), between January 2000 and December 2025.The causes included foreign body perforation (n=19), iatrogenic injury (n=15), spontaneous esophageal rupture (n=8), penetrating stab or gunshot injuries (n=3), and combined tracheal and esophageal injury following blunt chest trauma (n=2). Diagnosis was based on clinical examination, contrast esophagography, computed tomography, and esophagoscopy. Surgical management included mediastinal and pleural drainage, thoracotomy, primary repair of the esophageal defect whenever feasible, and intensive postoperative care. Computed tomography and contrast esophagography were the most informative diagnostic modalities for identifying esophageal perforation and assessing mediastinal involvement. The findings of this study support the importance of early diagnosis, prompt surgical management, and comprehensive postoperative care as the principal components of successful treatment of acute mediastinitis secondary to thoracic esophageal injury.

Keywords:

acute mediastinitis esophageal perforation thoracic esophagus esophageal injury thoracotomy computed tomography

References:

1. Axtell AL, Gaissert HA, Morse CR, Premkumar A, Schumacher L, Muniappan A, et al. Management and outcomes of esophageal perforation. Dis Esophagus. 2022;35(9):doac038. doi:10.1093/dote/doac038.
2. Chirica M, Kelly MD, Siboni S, Aiolfi A, Riva CG, Asti E, et al. Esophageal emergencies: WSES guidelines. World J Emerg Surg. 2019;14:26. doi:10.1186/s13017-019-0245-2.
3. DeVivo A, Sheng AY, Koyfman A, Long B. High risk and low prevalence diseases: esophageal perforation. Am J Emerg Med. 2022;58:208-215. doi:10.1016/j.ajem.2021.12.017.
4. Keogan AG, Rybachok A, Patel S, Latorre-Rodríguez AR, Vittori A, Mittal SK. Diagnostic utility of computed tomography in patients with spontaneous pneumomediastinum evaluated for suspected esophageal perforation. World J Surg. 2025;49(12):3362-3367. doi:10.1002/wjs.70158.
5. Khaitan PG, Famiglietti A, Watson TJ. The etiology, diagnosis, and management of esophageal perforation. J Gastrointest Surg. 2022;26(12):2444-2453. doi:10.1007/s11605-022-05370-5.
6. Luttikhold J, Pattynama LMD, Seewald S, Groth S, Morell BK, Gutschow CA, et al. Endoscopic vacuum therapy for esophageal perforation: a multicenter retrospective cohort study. Endoscopy. 2023;55(9):859-864. doi:10.1055/a-2042-6707.
7. Mathew G, Sohrabi C, Franchi T, Nicola M, Kerwan A, Agha R, et al.; PROCESS Group. Preferred Reporting of Case Series in Surgery (PROCESS) 2023 guidelines. Int J Surg. 2023;109(12):3760-3769. doi:10.1097/JS9.0000000000000940.
8. Nachira D, Sassorossi C, Petracca-Ciavarella L, Zanfrini E, Tabacco D, Pogliani L, et al. Management of esophageal perforations and postoperative leaks. Ann Esophagus. 2023;6:10. doi:10.21037/aoe-21-50.
9. Rausa E, Asti E, Aiolfi A, Bianco F, Bonitta G, Bonavina L. Comparison of endoscopic vacuum therapy versus endoscopic stenting for esophageal leaks: systematic review and meta-analysis. Dis Esophagus. 2018;31(11):doy060. doi:10.1093/dote/doy060.
10. Sdralis EIK, Petousis S, Rashid F, Lorenzi B, Charalabopoulos A. Epidemiology, diagnosis, and management of esophageal perforations: systematic review. Dis Esophagus. 2017;30(8):1-6. doi:10.1093/dote/dox003.
11. Shaqran TM, Engineer R, Abdalla EM, Alamoudi AA, Almahdi R, Aldhahri A, et al. The management of esophageal perforation: a systematic review. Cureus. 2024;16:e68652. doi:10.7759/cureus.63651.
12. Shaheem S, Panikkaveettil H. Aetiology, clinical manifestations, diagnosis, and treatment of oesophageal perforation: a review. Cureus. 2024;16:e69494. doi:10.7759/cureus.69494.
13. Søreide JA, Viste A. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med. 2011;19:66. doi:10.1186/1757-7241-19-66.
14. Stathopoulos P, Zumblick M, Wächter S, Schiffmann L, Gress TM, Bartsch D, et al. Endoscopic vacuum therapy for acute esophageal perforation: could it replace surgery? Endosc Int Open. 2022;10(5):E686-E693. doi:10.1055/a-1781-0827.
15. Wilson MK, Carr SR. Clinical applications of esophageal stents. Ann Esophagus. 2023;6:20. doi:10.21037/aoe-21-29.

Publication:

«World of Medicine and Biology» Vol. 22 No. 97 (2026), pp. 139-145
UDC 616.329-001-089:616.25-002-036.11

DOI:

https://doi.org/10.26724/2079-8334-2026-3-97-139-145