Acute mediastinitis is a life-threatening condition with a mortality rate of 30-40%. To discuss the pathophysiology of this disease, the authors reported the details of esophageal perforations experienced in our institute and reviewed the literature.
Eight cases of esophageal perforation, six men and two women, with a mean age of 48.3 years, were reported. There were five spontaneous perforations, and two iatrogenic perforations. The remaining one occurred from the rupture of the esophageal diverticulum. By plain chest X-ray films, mediastinal emphysema and pleural effusion were detected in 62.5% and 75%, respectively. Esophagography and endoscopic examination were diagnostic in 100% of the cases. In all but one case, the locations of the perforation were in the lower portion of the esophagus. All of the cases were treated surgically. One case died of the exsanguination of a hemorrhagic duodenal ulcer in hospital.
Nowadays, acute mediastinitis after cardiovascular surgery is the most common cause of acute mediastinitis whereas 90% of nonsurgical mediastinitis occurs from esophageal perforations. Descending necrotizing mediastinitis is a rare condition, but its mortality rate remains high. The pathogenic bacteria and pathways of the infectious extension are different for each source of acute mediastinitis. Therefore, appropriate therapeutic modalities, including antiseptic therapy and operative procedures, should be selected.
To decrease the mortality rate of this disease, immediate diagnosis and therapy are advocated.