Đặc điểm lâm sàng và cận lâm sàng áp xe trung thất do thủng thực quản điều trị tại Bệnh viện Hữu nghị Việt Đức

Abstract

Objective: To describe clinical and para-clinical which contributes to the diagnosis. Subject and method: A prospective study of mediastinal abscess due to perforation of the esophagus had been treated at Viet Duc Hospital from 1/2016 to 10/2019 including the deaths and discharged to die. The diagnosis criterias of mediatinal abscess was based on Estrera (1983) criterias, classified by Endo S (1999). Result: A total of 40 cases, average age: 48.5 ± 17.4 years old, accounting 82.5% male. The cause of esophageal perforation due to injury accounted for 70%, mainly by bone; due to disease 30%, in which Boerhaave syndrome accounted for 62.5%. The most common lesions in the upper third (cervical esophagus) accounted for 65%, at thoracic level (the middle third) accounted for 15%, and at thoracic level (the lower third) accounted for 20%. Classified by Endo: type I had 28 patients, accounting for 70%, no type IIa, type IIb had 12 cases, accounting for 30%. The main clinical signs: swallowing pain 35%, chest pain 42.5%, fever and difficulty breathing 75%. Local examination: Pain in carotid region 47.5%, loss of sound between laryngeal - spine 52.5%, subcutaneous emphysema 50%. X-ray examination: CT had high sensitivity and specificity, infiltration hypodensity images 95%, mediastinal gas 97.5%. 25/40 cases of bacteria/fungi were isolated (60%). Common Gram (+) bacteria had Streptococcus species (44%), Enterococcus faecalis (24%); Common Gram (-) had Acinetobacter baumannii (24%), Klebsiella pneumoniae (12%), Pseudomonas aeruginosa (8%). Fungis was isolated 6/24 cases, accounted for 25%. Conclusion: Descending necrotizing mediastinitis caused by esophageal perforation is a serious infectious complication and result in life threatening, with characterics of clinical and para-clinical features.