علاج التهاب المنصف الحاد الناجم عن انثقاب المريء مصحوباً بألم الرقبة أو الصدر والحمى

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.
• Primary repair of the perforation site is warranted whenever possible, even if the diagnosis is delayed >24 h, but the likelihood for breakdown of the repair is considered to increase substantially with a diagnostic delay >72 h.
• The repair site should be enhanced with the use of a vascularized pedicled flap (e.g. intercostal muscle, diaphragm, omentum or gastric fundus—depending on the location of the suture line), especially when there has been a delay in diagnosis and/or substantial extraluminal contamination was present.
• 'Primary repair' of the oesophageal perforation is recommended whenever possible within the first 72 h after perforation (Class I, Level of Evidence C).