MEDIASTINITIS WITHOUT ANTECEDENT SURGERY

The study evaluates the results of aggressive surgical treatment for m ediastinitis without antecedent surgery, after retrospectively reviewi ng all patients with mediastinitis, excluding patients with prior card iac, esophageal or mediastinal operations, treated between lune 1, 199 2 and August 1, 1996, 8 patients were treated, 7 were male, mean age w as 58 years. The etiology was Boerhaave's syndrome in 4, iatrogenic in jury in 2 and descending necrotizing mediastinitis in 2 patients. The mean number of operations was 2.5. The initial operation was through t horacotomy in 5 patients and sternotomy in 2 patients. 4 patients unde rwent neck drainage, 1 as primary treatment and 3 combined with transt horacic drainage. 1 patient received laparotomy, Mean hospitalization was 52 days (excluding 1 death). Complications included mechanical ven tilation greater than 48 hours in 7 patients, 2 or more operations in 5 patients, multisystem organ failure in 5 patients and other complica tions in 6 patients, Death occurred in one patient. Mediastinitis with out antecedent surgery is associated with significant morbidity, howev er, with aggressive surgical drainage 87% of patients survived.