Clinical Scenario

This protocol addresses acute mediastinitis arising as a direct consequence of oesophageal perforation — whether cervical or thoracic in origin. The presentation is characterised by neck and/or chest pain together with fever. This triad, particularly in the context of a recent endoscopic procedure, is strongly suggestive of iatrogenic oesophageal perforation with mediastinal involvement.

Mediastinitis resulting from oesophageal perforation carries high mortality rates. Early recognition of the perforation–mediastinitis link is critical to initiating timely intervention.

Initial Management Approach

Management centres on immediate systemic stabilisation: the patient is placed nil by mouth, and aggressive intravenous fluid resuscitation is started without delay. Broad-spectrum intravenous antibiotic therapy — covering both aerobic and anaerobic organisms — is a central component of the regimen. The full antibiotic selection, additional pharmacological measures, and decision points for escalation are detailed in the structured protocol.

References

DOI: 10.1093/ejcts/ezw326

Mediastinitis can result from cervical as well as from thoracic oesophageal perforations and is associated with high mortality rates.
A history of endoscopy in a patient with neck and/or chest pain in combination with fever is suggestive of an iatrogenic oesophageal perforation with possible mediastinal involvement.
The patient is made nil by mouth and should undergo aggressive fluid resuscitation along with IV broad-spectrum antibiotics covering aerobic and anaerobic bacteria.

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Treatment of Acute Mediastinitis Following Oesophageal Perforation with Neck or Chest Pain and Fever

Clinical Scenario

Initial Management Approach

References