Acute Mediastinitis in Children: A Nine-Year Experience

Authors

Pediatric Surgery Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran-IRAN

Abstract

Background: Acute mediastinitis is a serious medical condition with a mortality
rate of 30 to 40% or even higher. Early diagnosis with prompt and aggressive
treatment is essential to prevent its rapid progression. We evaluated acute
mediastinitis cases and analyzed the outcomes.
Materials and Methods: A retrospective chart review was conducted on
patients diagnosed with acute mediastinitis who were admitted to Mofid
Children’s Hospital from January 2001 to January 2010.
Results: Seventeen patients aged 1 to 10 yrs. (mean =3.8 yrs) were evaluated
including 12 (70%) boys and 5 (30%) girls. The most common symptoms were
fever, dyspnea, cyanosis, tachycardia and tachypnea. The etiology of
mediastinitis was iatrogenic esophageal perforation (EP), and related to
manipulation in 13(77%), and leakage of esophageal anastomosis in 4 cases
(33%). The underlying diseases were esophageal atresia in 2(12%), corrosive
injury of the esophagus in 13(76%), congenital esophageal stenosis in one (6%),
and gastroesophageal reflux esophagitis also in one (6%) patient. Patients with
clinical symptoms were evaluated by immediate chest radiography, and
gastrografin swallow. After early diagnosis, the patients received wide
spectrum antibiotics and immediate mediastinal or thoracic drainage, followed
by esophagostomy and gastrostomy. Only one case of endoscopic perforation
was managed by NG tube. Fifteen patients (88%) survived successfully. We had
2(12%) cases of mortality in our study (one patient after esophageal
substitution, mediastinal abscess and septicemia, and the other one developed
esophageal perforation 6 months after early management and died of cardiac
arrest during endoscopic dilation).
Conclusion: Prevention of acute mediastinitis is still a difficult challenge. As the
prognosis is not good and patients have high mortality, rapid management is
mandatory. 

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