Mediastinite por perfuração e ruptura do esôfago torácico

Abstract

BACKGROUND: To evaluate the mortality by mediastinitis and sepsis originated from ruptures and perfurations of the thoracic esophagus, according to length of diagnosis. METHODS: A retrospective study of 14 years (1992 to 2006) was carried out including patients with thoracic esophageal ruptures and perforations, stratified according to sex, age, mechanism of injury, evolution and treatment (< 24 hours and > 24 hours). RESULTS: Sample was composed of 44 patients, 10 females > (22,73%) and 34 males (77,27%). Age range was from 2 months to 77 years, mean 33,2 years. 19 cases (43,18%) were penetrating external trauma: stab in five cases and gunshot in 14. Endoscopic instrumentation was detected in nine cases (20,45%). Patients in whom esophagorraphy was carried out(early diagnosis, less than 24 hours) the mortality was occurred in three cases (20%). Patients in whom esophagectomy was carried out (later diagnosis, more than 24 hours), mortality occurred in eight cases (36,36%), without statistical significance (p >0,05). Considering conservative treatment, mortality was 71,4% (five out of seven cases) and the difference was statistically significant when compared with patients treated by surgery. CONCLUSION: Conservative treatment of mediastinitis from esophageal ruptures and Perforations showed a high mortality rate when compared to surgical treatment. Among surgical patients, the difference was not significant, reaffirming the indication of esophagectomy in advanced infection (more than 24 hours) and esophogorraphy in early cases.