Abstract
IntroductionAcute mediastinitis with esophageal perforation is a very fatal condition and must be treated promptly. Esophagomediastinal fistula is a rare complication of acute mediastinitis with esophageal perforation. There are many treatment options such as surgery or endoscopic treatment, but it is most important to start treatment immediately. Presentation of caseA 69-year-old female presented with chest pain and fever. Contrast enhanced chest computed tomography was compatible with acute mediastinitis and esophageal perforation. Esophagography revealed esophagomediastinal fistula in the upper esophagus. Endoscopic clipping with fibrin was failed and endoscopic vacuum therapy (EVT) was not effective for esophagomediastinal fistula. We performed the successful transcatheter embolization of the esophagomediastinal fistula with N-butyl cyanoacrylate (NBCA) glue. DiscussionThere are many considerations in the treatment of acute mediastinitis with esophageal perforation, but surgery is the mainstay of treatment. Recently non operative management is appropriate in certain well-defined situations. Like our case patients, non-operative management may be considered if the diagnosis is delayed and the surgical treatment period is missed. Currently, endoscopic treatment such as covered stenting, clipping and application of fibrin glue are useful and a less invasive rather than surgical treatment. However, if endoscopic or surgical procedure are not possible, we considered transcatheter NBCA glue embolization. ConclusionTranscatheter embolization with NBCA glue was proven to its effectiveness as an alternative therapeutic option in the treatment of esophagomediastinal fistula which endoscopic or surgical treatment are impossible or fails.
Highlights
Acute mediastinitis with esophageal perforation is a very fatal condition and must be treated promptly
Acute mediastinitis is a fatal infection which occurs related to connective tissue of the mediastinum
Esophageal perforation with acute mediastinitis can lead to sepsis and organ failure with very high mortality rate if diagnosis is missed or delayed [3]
Summary
Acute mediastinitis with esophageal perforation is a very fatal condition and must be treated promptly. Esophagomediastinal fistula is a rare complication of acute mediastinitis with esophageal perforation. DISCUSSION: There are many considerations in the treatment of acute mediastinitis with esophageal perforation, but surgery is the mainstay of treatment. Non-operative management may be considered if the diagnosis is delayed and the surgical treatment period is missed. Endoscopic treatment such as covered stenting, clipping and application of fibrin glue are useful and a less invasive rather than surgical treatment. CONCLUSION: Transcatheter embolization with NBCA glue was proven to its effectiveness as an alternative therapeutic option in the treatment of esophagomediastinal fistula which endoscopic or surgical treatment are impossible or fails
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