Mediastinitis associated with foreign body erosion of the esophagus in children

Objective: Timely and experienced intervention for esophageal foreign bodie s generally allows for removal with minimal morbidity. However, esophageal foreign bodies present a risk for esophageal perforation and subsequent med iastinitis, especially if the diagnosis of the foreign body is delayed. Alt hough much has been written about the management of esophageal foreign bodi es and their complications, little has been mentioned in recent literature about the specific complication of mediastinitis. This review was performed to examine our experience with this uncommon complication of esophageal fo reign bodies. Methods: A retrospective review of the esophageal foreign bod y database at Children's Hospital of Wisconsin from 1987 to 1997 was perfor med to identify patients with esophageal foreign bodies and subsequent medi astinitis. Results: Four patients with esophageal perforation with associat ed mediastinitis secondary to retained esophageal foreign bodies were ident ified. Three of the four patients were treated with conservative measures c onsisting of foreign body removal, intravenous antibiotics and discontinuin g of oral nutrition. These patients all achieved resolution of their medias tinitis and esophageal perforation with subsequent return to normal diets a nd no significant morbidity. One patient, with vascular erosion, required a ggressive, invasive therapy. Conclusion: From review of this limited number of patients, in the absence of major vascular erosion, conservative method s of treating children with foreign body esophageal perforation and subsequ ent mediastinitis appears to be effective. (C) 2001 Elsevier Science Irelan d Ltd. All rights reserved.