Öz
Mediastinal apse, orofaringeal apseler, boyun enfeksiyonları veya mediastene yayılan özofagus perforasyonuna sekonder hayatı tehdit eden bir komplikasyondur. Erken tanı ve tedavi hastanın hayatta kalması için çok önemlidir. Servikal ve torasik bölgenin BT taraması tanı ve takip için yararlı bir araçtır. Tedavi, geniş spektrumlu antibiyoterapi, yeterli cerrahi, mediastinal drenaj ve olası organ yetmezliğinin tedavisine dayanır. Standart bir cerrahi tutum yoktur. 57 yaş erkek hasta 1 hafta önce kemikli et yerken göğüs ağrısı ve yutma güçlüğü, yüksek ateş şikayeti olan hastaya yapılan tetkikler sonucu mediastinal apse tespit edildi. Geniş spektrumlu antibiyoterapi başlandı. Mediastinal apse, perkütan katater ile drene edildi. Ek cerrahi bir prosedür uygulamaya gerek kalmadan hasta taburcu edildi. Mediastinal apsenin mortalitesi %20-40 arasındadır. Hızlı tanı konulduğunda ve torasik drenaj etkili olduğunda minimal invaziv yaklaşım tatmin edici olabilir.
Anahtar Kelimeler
Mediasten Apse Özofagus Perforasyonu Yabancı Cisim Drenaj Mediastinum Abscess Esophageal Perforation Foreign Body Drainage
Kaynakça
- Nirula R. Esophageal Perforation. Surg Clin North Am. 2014;94(1):35-41. DOI:10.1016/j. suc.2013.10.003
- Ridder GJ, Maier W, Kinzer S, Teszler CB, Boedeker CC, Pfeiffer J. Descending necrotizing mediastinitis: Contemporary trends in etiology, diagnosis, management, and outcome. Ann Surg. 2010;251(3):528-534. DOI: 10.1097/SLA.0b013e3181c1b0d1
- Salehi Omran A, Karimi A, Ahmadi SH, Davoodi S, Marzban M, Movahedi N, et al. Superficial and deep sternal wound infection after more than 9000 coronary artery bypass graft (CABG): Incidence, risk factors and mortality. BMC Infect Dis. 2007;7:112.
- Petitpas F, Blancal JP, Mateo J, Farhat I, Naija W, Porcher R, et al. Factors associated with the mediastinal spread of cervical necrotizing fasciitis. Ann Thorac Surg. 2012;93(1):234-238. DOI: 10.1016/j.athoracsur.2011.09.012.
- Chang CH, Huang JY, Lai PC, Yang CW. Posterior mediastinal abscess in a hemodialysis patient a rare but life-threatening complication of Staphylococcus bacteremia. Clin Nephrol. 2009;71(1):92-95. DOI: 10.5414/cnp71092.
- Kilic D, Findikcioglu A, Ates U, Hekimoglu K, Hatipoglu A. Management of descending mediastinal infections with an unusual cause: a report of 3 cases. Ann Thorac Cardiovasc Surg. 2010;16:198-202.
- Moffatt-Bruce SD, Ross P Jr. Mediastinal abscess after endobronchial ultrasound with transbronchial needle aspiration: a case report. J Cardiothorac Surg. 2010;5:33.
- Nah JC, Lee B, Kwak CH, Kim SB, Kim SM, Park SW. Spontaneous rupture of idiopathic thymic abscess with a markedly increased CA-125 level. Intern Med. 2008;10:953-956.
- Bungay HK, Shefler AG, McHugh K. CT of staphylococcal anterior mediastinal abscess in an infant. Pediatr Radiol. 1995;25:205-206.
- Gupta RK, Sharma BK, Jena A, Pant K, Prakash R, Talukdar B. Primary mediastinal tuberculous abscess: demonstration with MR. Pediatr Radiol. 1989;19:330–332.
- Ishikawa Y, Ogawa J, Mohri T, Inoue H. A case of acute idiopathic mediastinitis that responded rapidly to treatment. J Japan Thor Soc. 1994;32:1213-1216.
- Fields JM, Schwartz DS, Gosche J, Keller MS. Idiopathic bilateral anterior mediastinal abscesses. Pediatr Radiol. 1997;27:596-597.
- Doddoli C, Trousse D, Avaro JP, Djourno XB, Giudicelli R, Fuentes P, Thomas P. Acute mediastinitis except in a context of cardiac surgery. Rev Pneumol Kliniği. 2010;66(1):71-80.
Öz
Mediastinal abscess is a life-threatening complication secondary to oropharyngeal abscesses, neck infections, or esophageal perforation spreading to the mediastinum. Early diagnosis and treatment is very important for patient survival. CT scan of the cervical and thoracic region is a useful tool for diagnosis and follow-up. Treatment is based on broad-spectrum antibiotics, adequate surgery, mediastinal drainage, and management of possible organ failure. There is no standard surgical approach. A mediastinal abscess was detected in a 57-year-old male patient, who had chest pain, difficulty in swallowing, and high fever while eating bony meat 1 week ago. Broad spectrum antibiotics were started. Mediastinal abscess was drained with a percutaneous catheter. The patient was discharged without the need for an additional surgical procedure. Mortality of mediastinal abscess is between 20-40%. A minimally invasive approach may be satisfactory when a prompt diagnosis is made and thoracic drainage is effective.
Anahtar Kelimeler
Mediasten Apse Özofagus Perforasyonu Yabancı Cisim Drenaj Mediastinum Abscess Esophageal Perforation Foreign Body Drainage Mediastinum, Abscess, Esophageal Perforation, Foreign Body, Drainage
Kaynakça
- Nirula R. Esophageal Perforation. Surg Clin North Am. 2014;94(1):35-41. DOI:10.1016/j. suc.2013.10.003
- Ridder GJ, Maier W, Kinzer S, Teszler CB, Boedeker CC, Pfeiffer J. Descending necrotizing mediastinitis: Contemporary trends in etiology, diagnosis, management, and outcome. Ann Surg. 2010;251(3):528-534. DOI: 10.1097/SLA.0b013e3181c1b0d1
- Salehi Omran A, Karimi A, Ahmadi SH, Davoodi S, Marzban M, Movahedi N, et al. Superficial and deep sternal wound infection after more than 9000 coronary artery bypass graft (CABG): Incidence, risk factors and mortality. BMC Infect Dis. 2007;7:112.
- Petitpas F, Blancal JP, Mateo J, Farhat I, Naija W, Porcher R, et al. Factors associated with the mediastinal spread of cervical necrotizing fasciitis. Ann Thorac Surg. 2012;93(1):234-238. DOI: 10.1016/j.athoracsur.2011.09.012.
- Chang CH, Huang JY, Lai PC, Yang CW. Posterior mediastinal abscess in a hemodialysis patient a rare but life-threatening complication of Staphylococcus bacteremia. Clin Nephrol. 2009;71(1):92-95. DOI: 10.5414/cnp71092.
- Kilic D, Findikcioglu A, Ates U, Hekimoglu K, Hatipoglu A. Management of descending mediastinal infections with an unusual cause: a report of 3 cases. Ann Thorac Cardiovasc Surg. 2010;16:198-202.
- Moffatt-Bruce SD, Ross P Jr. Mediastinal abscess after endobronchial ultrasound with transbronchial needle aspiration: a case report. J Cardiothorac Surg. 2010;5:33.
- Nah JC, Lee B, Kwak CH, Kim SB, Kim SM, Park SW. Spontaneous rupture of idiopathic thymic abscess with a markedly increased CA-125 level. Intern Med. 2008;10:953-956.
- Bungay HK, Shefler AG, McHugh K. CT of staphylococcal anterior mediastinal abscess in an infant. Pediatr Radiol. 1995;25:205-206.
- Gupta RK, Sharma BK, Jena A, Pant K, Prakash R, Talukdar B. Primary mediastinal tuberculous abscess: demonstration with MR. Pediatr Radiol. 1989;19:330–332.
- Ishikawa Y, Ogawa J, Mohri T, Inoue H. A case of acute idiopathic mediastinitis that responded rapidly to treatment. J Japan Thor Soc. 1994;32:1213-1216.
- Fields JM, Schwartz DS, Gosche J, Keller MS. Idiopathic bilateral anterior mediastinal abscesses. Pediatr Radiol. 1997;27:596-597.
- Doddoli C, Trousse D, Avaro JP, Djourno XB, Giudicelli R, Fuentes P, Thomas P. Acute mediastinitis except in a context of cardiac surgery. Rev Pneumol Kliniği. 2010;66(1):71-80.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Cerrahi |
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Şubat 2023 |
| Gönderilme Tarihi | 15 Aralık 2022 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 1 Sayı: 1 |
