Successful treatment of mediastinal gas gangrene due to esophageal perforation

Esophageal perforation and mediastinal gas gangrene developed in a 55-year- old male after the endoscopic ethanol injection of a Mallory-Weiss ulcer. I nitially, extensive gangrene of the esophagus and the mediastinum was treat ed by esophagectomy; however, an abundance of Clostridium perfringens in th e Gram stain verified the presence of gas gangrene. Subsequently, the patie nt was transferred to a hyperbaric oxygen center, wherein a total of seven hyperbaric treatments were administered. The patient survived, and 4 months later, after having undergone several reoperations because of pleural empy ema, mediastinal abscess, splenic rupture, and acalculous cholecystitis, wa s discharged and is still surviving. (Ann Thorac Surg 2000;70:2143-5) (C) 2 000 by The Society of Thoracic Surgeons.