Videothoracoscopic drainage of mediastinal abscess: an alternative to thoracotomy

Successful percutaneous drainage of a refractory caudal mediastinal paraesophageal abscess in a dog

OBJECTIVE

To describe a novel technique for paraesophageal abscess drainage in a dog.

CASE SUMMARY

A 6-year-old dog presented for pyrexia of unknown origin, subsequently confirmed to be due to a paraesophageal abscess. This was managed by the ultrasound-guided placement of a thoracostomy tube into the abscess, allowing drainage to be performed. This led to clinical resolution and, at an 8-month follow-up, the dog continued to do well.

NEW OR UNIQUE INFORMATION PROVIDED

Paraesophageal abscessation is typically managed with surgical intervention, which carries inherent risks and complications. This report describes a novel technique that did not require general anesthesia or invasive surgical intervention, achieving clinical remission without any adverse effects. It also summarizes the current literature available on this condition.

Placement of transnasal drainage catheter and covered esophageal stent for the treatment of perforated esophageal carcinoma with mediastinal abscess

BACKGROUND AND OBJECTIVES

Perforated esophageal carcinoma with mediastinal abscess is a clinically life-threatening emergency. Herein, we summarize our experience with placement of transnasal drainage catheters and covered esophageal stents for the treatment of this condition.

METHODS

We retrospectively assessed the medical records of 20 patients who were treated using our intervention protocol. Patients received local anesthesia and sedation prior to transnasal drainage catheter placement into the mediastinal abscess, which was followed by esophageal stent placement. Once the fluid was completely drained and the abscess was completely closed, the drainage catheter was removed.

RESULTS

The placement of the drainage catheter and stent was successful in all patients. The drainage catheter was successfully removed from the mediastinum after 7-60 days in 14 patients. During the follow-up of 1-18 months, six patients died from hemorrhage, eight from cancer progression or pulmonary infection, one from atrial fibrillation, and one from asphyxia caused by tracheal compression. The remaining four patients can eat normally.

CONCLUSIONS

Placement of transnasal drainage catheters and covered esophageal stents may be an appropriate palliative therapy for patients with perforated esophageal carcinoma with mediastinal abscess who are not candidates for surgery or have a high postoperative risk. J. Surg. Oncol. 2016;114:725-730. © 2016 Wiley Periodicals, Inc.

A novel treatment for inferior mediastinal abscess via abdominal laparoscopy

Mediastinal abscess can be managed through a variety of both invasive and minimally invasive methods, as determined by location and spread of infection. Thoracotomy remains the gold standard in treatment and is often employed. In the present case, a 54-year-old female with chronic pancreatitis presented with a 1-week history of severe epigastric pain, nausea and vomiting. On CT scan, a large abscess was discovered in the anterior inferior mediastinum. She was taken to the operating room and underwent laparoscopic drainage of the abscess. Laparoscopy represents a novel approach in management of anterior inferior mediastinal abscess.

Biópsia do miocárdio em cães: acesso minimamente invasivo por cirurgia torácica videoassistida

Realizou-se uma série de biópsias cardíacas em cães para testar o acesso toracoscópico, utilizando-se oito cães sem raça definida, sob condições de manejo e alimentação adequados. A abordagem à cavidade torácica foi feita por meio de cirurgia torácica videoassistida e o instrumental utilizado para remoção do fragmento de miocárdio foi o convencional em lugar das pinças de videocirurgia. A eficácia do procedimento foi confirmada pelo tempo decorrido entre as incisões, a execução da biópsia e a sutura do tórax, com duração média de 15 minutos. A cirurgia torácica videoassistida para biópsias cardíacas foi considerada segura e adequada, minimizando o desconforto pós-operatório dos pacientes submetidos ao acesso torácico.

Endoscopic debridement of paraesophageal, mediastinal abscesses: a prospective case series

BACKGROUND

Mediastinal abscesses after esophageal perforation or postoperative leakage nearly always require surgical intervention.

METHODS

Patients with paraesophageal abscesses were treated with EUS-guided or endoscopic mediastinal puncture if the abscess was >2 cm and sepsis was present. Abscess cavities were entered with a 9.5-mm endoscope after balloon dilation to allow irrigation and drainage. Debris was removed with a Dormia basket. Concomitant pleural effusions were treated with transthoracic drains. Patients received intravenous antibiotics and enteral/parenteral nutrition.

RESULTS

Twenty patients fulfilled the entry criteria. Simple drainage was sufficient in 4 cases, and puncture was impossible in one case. Of the 15 treated patients (age 39-76 years, 5 women) the etiology of perforation was Boerhaave's syndrome (n = 8), anastomotic leak (n = 3), and iatrogenic perforation (n = 4). Debridement was successful in all cases and required a median of 5 daily sessions (range 3-10). All patients became apyrexial, with a C-reactive protein < 5 mg/L within a median of 4 days (range 2-8 days). Esophageal defects were closed with endoclips (n = 7), fibrin glue (n = 4), metal stents (n = 1), or spontaneously healed (n = 3). One patient died from a massive pulmonary embolism one day after successful debridement (mortality 7%). No other complications were seen. Median follow-up was 12 months (range 3-40 months).

CONCLUSIONS

Nonoperative endoscopic transesophageal debridement of mediastinal abscesses appears safe and effective.