Emergency Oesophagectomy and Proximal Deviating Oesophagostomy for Fulminent Mediastinal Sepsis

OBJECTIVE: To evaluate an aggressive surgical strategy in patients with mediastinal sepsis as a result of oesophageal leakage. DESIGN: A prospective clinical study. SETTING: University hospital, Sweden. SUBJECTS: 11 consecutive patients who presented with mediastinal sepsis as a result of a damaged oesophagus caused by instrumental perforation in 4 cases and spontaneous rupture in 6 cases during a 6-year period. INTERVENTIONS: Ten patients were treated with oesophagectomy with a diverting proximal oesophagostomy and in one case a primary cervical oesophagogastrostomy was done after emergency resection. MAIN OUTCOME MEASURES: Mortality and morbidity. RESULTS: The median delay from onset of symptoms to admission to the unit was 3 days (range 0-6). All patients required artificial ventilation postoperatively and the stay in the ICU amounted to 12.5 days but only 1 patient died during the postoperative course. All patients have subsequently undergone substernal oesophageal replacement with either a gastric tube or a colonic graft. CONCLUSION: Emergency oesophagectomy and proximal deviating oesophagostomy is a salvage procedure for patients with severe fulminant mediastinal sepsis, and it can be done in selected cases with good results.