علاج التهاب المنصف الحاد الناجم عن ثقب المريء (العنقي أو الصدري)

References

• 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.
• Oesophageal endoscopic covered stents can be useful for the management of an oesophageal perforation in selected patients.
• ‘Oesophageal stenting in combination with pleural/mediastinal drainage’ maybe be considered in haemodynamically stable cases with a contained leakage from the oesophagus in the early course after perforation (<24 h).
• ‘Drainage alone’ should be used for perforations of the cervical oesophagus which cannot be visualized, but only in the absence of any distal obstruction (Class IIb, Level of Evidence C).
• ‘Oesophagectomy’ may be proposed in the presence of oesophageal malignancy or in case of irrepairable extensive oesophageal damage (Class IIb, Level of Evidence C).
• ‘Diversion’ may be an option when all of the above-mentioned treatment possibilities have been exhausted; especially when patients present with clinical instability and cannot tolerate an extensive operative procedure, or in cases of extensive oesophageal damage not amenable to primary repair (Class IIb, Level of Evidence C).