New Device for Endoscopic Vacuum-Assisted Closure (E-Vac) in Acute Mediastinitis from Esophageal Perforation

Abstract

Acute mediastinitisis an uncommon but potentially devastating infection involving the structures of the mediastinum. The 2 most common causes of acute mediastinitis are esophageal perforation or median sternotomy. Conventional forms of treatment for acute mediastinitisusually involve surgical revision with open dressings or closed irrigation, or reconstruction with vascularized soft tissue flaps such as omentum or pectoral muscle. Vacuum-assisted closure is a treatment with a wound-healing technique based on the application of local negative pressure to a wound. We present the case of a 73 years old male patient admitted in our clinic with esophageal perforation that appeared possible after a endoscopic dilatation done for a esophageal stenosis in the inferior 1/3 part. Using a modified double-lumen naso-gastrig probe adapted to the negative pressure unit and using the same principle as in the negative pressure treatment of soft tissue wounds we have achieved positive results with successful cure of esophageal perforation. The toraco-abdominal Computer Tomography done with contrast substance confirmed the esophageal perforation, acute mediastinitis and bilateral pleuresia. The patient had a full recovery after 29 days of hospitalization with a positive check-up at one and two months after leaving our clinic.