Acute mediastinitis: surgical treatment and outcomes – experience of our department

Czech version

Authors: M. Skála ¹ ; J. Vodička ¹ ; J. Šebek ¹; J. Geiger ¹; J. Moláček ¹ ; A. Židková ²; P. Andrle ³ ; L. Geigerová ⁴; H. Mírka ⁵; D. Slouka ⁶
Authors‘ workplace: Chirurgická klinika LF UK a FN Plzeň ¹; Klinika anesteziologie, resuscitace a intenzivní medicíny LF UK a FN Plzeň ²; Stomatologická klinika LF UK a FN Plzeň ³; Ústav mikrobiologie LF UK a FN Plzeň ⁴; Klinika zobrazovacích metod LF UK a FN Plzeň ⁵; Klinika otorinolaryngologie a chirurgie hlavy a krku LF UK a FN Plzeň ⁶
Published in: Otorinolaryngol Foniatr, 75, 2026, No. 1, pp. 46-53.
Category: Original Article
doi: https://doi.org/10.48095/ccorl202646

Overview

Introduction: Acute mediastinitis is a potentially fatal, diffuse inflammatory condition of the mediastinum with a mortality rate of up to 20%. Causes include esophageal perforation, descending infection from the neck, sternotomy infection, spread of infection from the pleural cavity in cases of empyema, or hematogenous spread of infection from other sites. It typically affects individuals in their 5^th to 6^th decade of life, more often men, who often present with risk factors such as type II diabetes mellitus, alcohol abuse, obesity, liver cirrhosis, and others. The infection is usually polymicrobial, both aerobic and anaerobic, with Streptococcus sp. strains being predominant initially, followed by mycotic superinfection in up to half of the cases. Aim: The authors present a retrospective analysis of a cohort of patients with acute mediastinitis treated over a nineteen-year period and their own experience with the surgical treatment of this disease. Methods: From 2006 to 2024, we treated 101 patients with acute mediastinitis (67 men, 34 women), with a median age of 56 years (range 19–98 years). In this cohort, we monitored the causes and type of acute mediastinitis, duration of symptoms, comorbidities, diagnostic methods, time from diagnosis to surgery, types and numbers of surgical procedures, microbiological findings, duration of drainage and hospitalization, complications, and treatment outcomes. Results: The most common type of acute mediastinitis was descending mediastinitis (51.5%). The median duration of symptoms was 2 days, and the median time from diagnosis of acute mediastinitis to surgical intervention was 4 hours and 51 minutes. A total of 158 surgical procedures were performed. Esophageal perforation was managed by placing an esophageal stent, either alone or as reinforcement of the suture. Significant complications were recorded in 67 cases. Significant comorbidities were present in 76.2% of patients. The most common pathogenic strain was Streptococcus sp. (59 cases), with Streptococcus anginosus being the most frequent specific pathogen (22 cases). Sixteen patients (15.8%) died in the cohort, including 7 patients with descending mediastinitis and 9 patients with esophageal perforation. Conclusion: For the treatment of acute mediastinitis, early elimination of its cause, adequate mediastinal debridement, and multiple drainage sites with the possibility of continuous postoperative lavage are crucial. We have very good experience with the use of stents in managing esophageal perforation.

Keywords:

descendent necrotizing mediastinitis – acute mediastinitis – esophageal perforation

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