Mediastinitis

Description:

The mediastinum cellulose inflammation, is caused more often by a purulent nonspecific infection. Arises as initially (an injury of bodies of a mediastinum), and for the second time (a complication of various purulent processes in an organism).

Symptoms of Mediastenit:

Weight of a current, complexity of early diagnosis and big lethality distinguish a disease. Distinguish 3 forms of mediastinites: acute not purulent, acute purulent and chronic.

Retrosternal pains, asthma, oznoba, fever are typical for acute forms. Especially hard purulent mediastinites at which retrosternal pains are sharply expressed and constant proceed. Characteristic is the sudden acute beginning with rough manifestation of various symptoms. All signs can be divided into two groups: the general, caused by intoxication, and the symptoms caused by a local prelum of bodies, vessels and nerves. The most justified should consider the active surgical tactics obligatory for purulent forms of a disease. Weight of a current of chronic mediastinites is caused by development in connecting fabric of the fibrous hems squeezing bodies of a mediastinum. Treatment at chronic mediastinites generally conservative: antibioticotherapia, roentgenotherapy. An operative measure is shown in rare instances at a strong prelum by hems of this or that body of a mediastinum

Symptoms and current. Weight of a current, complexity of early diagnosis and a big lethality distinguish a disease. Distinguish 3 forms of mediastinites: acute not purulent, acute purulent and chronic.

Retrosternal pains, asthma, oznoba, fever are typical for acute forms. Especially hard purulent mediastinites at which retrosternal pains are sharply expressed and constant proceed. Characteristic is the sudden acute beginning with rough manifestation of various symptoms. All signs can be divided into two groups: the general, caused by intoxication, and the symptoms caused by a local prelum of bodies, vessels and nerves. The most justified should consider the active surgical tactics obligatory for purulent forms of a disease.

Weight of a current of chronic mediastinites is caused by development in connecting fabric of the fibrous hems squeezing bodies of a mediastinum.

Reasons of Mediastenit:

Reasons of an acute mediastinitis: open damages; the closed injury (hematoma suppuration); perforation of a gullet; complications of operations on a gullet, trachea, large bronchial tubes, mediastinoskopiya, pnevmomediastinografiya; contact spread of an infection; metastatic spread of an infection.

By origin distinguish primary (traumatic) and secondary mediastinites. Primary mediastinites arise at wounds and the closed damages of a mediastinum and its bodies, and also after operational and endoscopic interventions on them.

Acute primary mediastinitis at wounds of a mediastinum meets infrequently. It has a talk, mainly, rather small number of victims with open damages of a mediastinum who are managed to be brought to medical institutions. Most of them quickly dies on the spot incidents because of the heavy combined damages and massive blood loss. So, by experience of the Great Patriotic War and the last local military conflicts, the frequency of wounds of a mediastinum in relation to the getting breast wounds at the arriving wounded, made only about 0,5%.

Emergence and weight of infectious process in a mediastinum is usually connected with a type of weapon and a hurting shell, the nature of wound (through, blind), existence or absence of damage of internals. Promotes progressing of a surgical infection the high level of a bacterial obsemenennost, virulence of microflora which are formed as a result of an injury a mediastinal hematoma and a traumatic necrosis of cellulose of a mediastinum. In development of a purulent complication the initial condition of an organism at the time of wound and decrease in its protective forces in response to acute blood loss and heavy traumatic shock is important.

The purulent mediastinitis can be for the development reasons: wound, perforative, postoperative.

Sometimes the source of a mediastinitis remains not revealed (so-called cryptogenic mediastinites).

Depending on character of an inflammation allocate serous (not purulent), purulent, putrefactive, anaerobic and gangrenous forms of an acute mediastinitis. Infectious inflammatory process in a fatty tissue of a mediastinum can be caused by various microorganisms: most often it is streptococci and staphylococcus, is more rare - pneumococci, colibacillus, proteas, etc. Quite often the combination of purulent and putrefactive microflora is found. Researches of the last years proved value of sporeless anaerobe bacterias in development of an intrathoracic infection including mediastinites.

Treatment of Mediastenit:

At an acute purulent mediastinitis early surgical treatment at once on establishment of the diagnosis is necessary. Only cases when the mediastinitis develops gradually (for example, at dot perforation of a gullet, its development from the infected lymph nodes) can make an exception, is in a stage of a serous inflammation, has limited character and is not followed by development of serious condition of the patient. In these cases conservative therapy, on condition of dynamic observation of the patient in a surgical hospital can be used.

Surgical treatment is directed, first of all, to elimination of the reason which caused an acute mediastinitis, opening of the inflammatory center (mediastinotomy) and its adequate drainage. Without timely rendering the surgical help the acute purulent mediastinitis almost always comes to an end with a lethal outcome. The operational grant should be carried out even at a serious general condition of the patient, after the short-term preoperative intense training directed to correction of disturbances of a homeostasis and elimination of disorders of the vital functions.