Mediastinitis
Mediastinitis is a serous or purulent inflammation of the mediastinal tissue. Occurs with inflammatory diseases or perforations of the mediastinum; Lymphadenitis with abscessing, empyema of the pleura, lung abscess with perforation in the mediastinum. In recent years, mediastinitis caused by instrumental perforations of the esophagus, trachea, and bronchi has become more frequent. Infection can get into the mediastinum and indirect way (lymphogenous) with inflammatory changes of neighboring organs: lungs, ribs, neck. The main localization of the inflammatory process is the upper mediastinum. The main etiological factors are instrumental perforations and the spread of odontogenic phlegmon of the neck to the mediastinal fiber.
Symptoms, course. The course of the disease is severe. Mediastinitis as a complication of a number of diseases is manifested by worsening of the condition with the already existing severe pathology. When there is mediastinitis against the background of odontogenic phlegmon of the neck, the patient has pain behind the sternum, high fever, chills, and tachycardia. When examining the neck marked sharply painful inflammatory infiltration, reaching the collarbone. If the phlegmon necrosis was previously performed, a significant detachable, sometimes with an unpleasant putrefactive odor, leaves the wound. When you tap the sternum, the pain intensifies. In the blood - high leukocytosis with a shift of the formula to the left. X-ray examination reveals an expansion of the shadow of the mediastinum.
With instrumental perforation of the esophagus, damage to the pear-shaped sinus occurs more often. Due to insufflation of air at the time of the study, the infection spreads rapidly through the mediastinum. Signs of intoxication appear very early and are rapidly progressing. Often immediately after the study, subcutaneous crepitus on the neck, chest pain with irradiation in the neck and interscapular space are noted. After a few hours, the temperature rises significantly, chills, profuse sweat, tachycardia, there may be clinical manifestations of septic shock. In the blood - high leukocytosis with a shift of the formula to the left. X-ray-expansion of the shadow of the mediastinum, emphysema of the mediastinum, neck. When contrasting the esophagus (only water-soluble contrast agents), you can identify the location and size of the perforation, however, when microperforating, the flow of contrast beyond the esophagus is difficult to detect.
Treatment. Produce drainage of mediastinal fat, more often by cervical access. Two-lumen drainage is removed through a separate incision, the mediastinotomic wound is sealed. After the operation, an active aspiration of the cavity and drainage to be separated is carried out. With mediastinitis on the basis of perforation of the esophagus in endoscopy, it is usually not possible to suture the defect, effectively draining the mediastinum. The patient is fed through a soft receding probe inserted into the stomach. Massive disintoxication therapy is also carried out, antibiotics of a wide spectrum of action are introduced.
With significant lesions of the thoracic esophagus accompanied by damage to the pleural leaf, short periods (less than a day) after perforation, transthoracic suturing of the defect, drainage of the mediastinum and pleural cavity are performed. After the operation, the patient is probed.
Complications: sepsis, empyema of the pleura, the development of mediastinal fibrosis is possible in the long term.
The forecast is always very serious. It depends on the nature of the underlying disease, the entrance gate of the infection, the type of pathogen.
Chronic mediastinitis is often the result of tuberculosis infection (bronchadenitis), fungal lesions, acute acute purulent mediastinitis. Clinical manifestations are caused by developing fibrosis of mediastinal fiber and progressive compressed upper vena cava, esophagus, and pulmonary veins. Patients complain of pain, fever, dyspnoea with physical exertion, a change in the voice (depressed reflex nerves). Clinical manifestations correspond to the degree of expansion of the mediastinum in the x-ray examination of the chest. Signs of compression of the superior vena cava are noted even in the absence of radiological changes.
The diagnosis is specified in angiographic and tomographic studies.
Treatment operative. During the operation, the morphological and etiological diagnosis is refined.
The prognosis is serious.
- Surgical diseases
- Abscess
- Abscess appendicular
- Abscesses of the abdominal cavity
- Abscess of the Douglas space
- Intestinal abscess
- Abscess of the lung
- Soft tissue abscess
- Abscesses of soft tissues after injection
- Abscess of liver
- Amoebic liver abscess
- Prostate adenoma
- Actinomycosis
- Aneurysm
- False aneurysm
- True aneurysms
- Aneurysm of the aortic arch
- Aneurysm of descending thoracic aorta
- Dissecting Aneurysm
- Aneurysm of the abdominal aorta
- Aneurysm of peripheral vessels
- Arteriovenous aneurysm
- Aneurimas of the heart
- Appendicitis acute
- Perforation of the appendage
- Appendicular infiltration
- Pielephlebitis
- Atheroma
- Bronchoectasis
- Varicose veins
- Varicose veins of the spermatic cord
- Dropsy of testis and spermatic cord
- Rectal prolapse
- Gangrene gas
- Gangrene lung
- Hemorrhoids
- Hydradenite
- Gynecomastia
- Hernia
- Internal hernias
- Hernias of the esophagus
- External hernias
- Herniated hernias
- Herniated hernia
- Hernia of the white line
- Hernia postoperative ventral
- Herniated hernia
- Rare hernias
- Pincushion
- Phlegmon hernial sac
- False infringement of a hernia
- Hernias with inflammation
- Dumping syndrome
- Diverticulum
- Esophagus diverticulum
- Cervical diverticulum
- Bifurcation diverticulum
- Epiphrenial diverticulum
- Epiphrenial diverticulum
- Diverticulum of the stomach
- Diverticulum of the duodenum
- Meckel's diverticulum
- Jaundice mechanical
- Bile duct stones
- Ventilated stone of choledoch
- Papillotenosis
- Stricture of bile ducts
- Cancer of the head of the pancreas
- Cholelithiasis
- Urinary retention acute
- Zollinger-Ellison syndrome
- Foreign bodies of bronchi
- Foreign bodies of the stomach
- Foreign bodies of the esophagus
- Foreign bodies of soft tissues
- Carbuncle
- Brushes and fistulas of the neck are lateral
- Cysts and fistulas of the neck median
- Colitis ulcerative ulcerative
- Coccygeal epithelial passage
- Cryptorchidism
- Bleeding
- Bleeding internal
- Bleeding gastrointestinal
- Varicose veins
- The Mallory-Weiss Syndrome
- Bleeding into the abdominal cavity
- Bleeding pulmonary
- Bleeding external
- Parenchymal hemorrhage
- Crohn's disease
- Lymphadenitis
- Lymphangitis
- Mastitis
- Putrefactive mastitis
- Acute non-lactational mastitis
- Chronic mastitis
- Megacolon
- Intestinal obstruction
- Paralytic intestinal obstruction
- Mechanical intestinal obstruction
- X-ray diagnostics
- Specific types of intestinal obstruction
- Ingrown throat
- Frostbite
- Local cooling
- Burn
- Occlusion of the main arteries
- Acute occlusion of the vessels of the extremities
- Acute occlusion of mesenteric vessels
- Chronic occlusions of arterial vessels
- Obtiterating atherosclerosis
- Aortic ileal type
- Hips and popliteal type
- Peripheral type
- Occlusion of aortic arch branches
- Occlusion of carotid arteries
- Occlusion of the subclavian artery
- Takayasu's syndrome (absence of pulse)
- Chronic occlusion of mesenteric vessels (abdominal toad)
- Stenosis of the renal arteries
- Obliterating thrombangitis
- Raynaud's disease
- Orcoepididymitis
- Acute abdomen
- Acute pancreatitis
- Chronic pancreatitis
- Acute cholecystitis
- Panaritium
- Panaritium cutaneous
- Paronichy
- Panaritium subungual
- Panaritium tendinous
- Panaritium articular
- Panaritium bone
- Penetrating ulcer of the stomach and duodenum
- Peritonitis
- Peritonitis chronic
- Piopevneumotorax
- Pneumothorax spontaneous
- Postcholecystectomy syndrome
- Perforated ulcer
- Covered perforation
- Bedsore
- Prostatitis
- Wounds
- Fistulas of the rectum
- Stenosis of the outlet stomach
- Fracture of anus
- Urethritis
- Phimosis, paraphimosis
- Phlebothrombosis
- Occlusion of subclavian vein
- Phlegmon
- Furuncle
- Cholangitis
- Electric trauma
- Empyema of the pleura
- Congenital intestinal obstruction
- Atresia of the anus
- Congenital cholangiopathy of newborns
- Pylorostenosis
- Embryonic hernia (hernia of umbilical cord)
- Exstrophy of the bladder
- Dropsy of shells of testis and spermatic cord
- Surgical diseases of the chest
- Congenital diaphragmatic hernia
- Congenital cysts of the lungs
- Pneumothorax
- Tracheophishoprine fistula
- Mastitis of newborns
- Acute hematogenous osteomyelitis
- Peritonitis in newborns
- Acute paraproctitis
- Necrotic phlegmon of newborns
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