ĐẶC ĐIỂM LÂM SÀNG VÀ CẬN LÂM SÀNG ÁP XE TRUNG THẤT DO THỦNG THỰC QUẢN ĐIỀU TRỊ TẠI BỆNH VIỆN VIỆT ĐỨC

Abstract

Purpose: Descending necrotizing mediastinitis represent a virulent form of mediastinal infection caused by oropharyngeal infection spreading along, especially cause of the perforation of the esophagus with high risk of mortality. Aim of our study is to describe clinical and para-clinical which contributes to the diagnosis. Materials and Methods: A prospective study of mediastinal abscess due to perforation of the esophagus have been treated in 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). Results: A total of 40 cases, average age: 48,5 ± 17,4 years old, accounting for 82.5% male. The cause of esophageal perforation due to injury accounts for 70%, mainly by bone; due to disease 30%, in which Boerhaave syndrome accounts 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 has 28 patients, accounting for 70%, no type IIa, type IIb has 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 32.5%. X-ray examination: CT had high sensitivity and specificity, 71.4% infiltration images, 46.4% mediastinal gas (type I); hypodensity in the mediastinum 100%, pleural pus 83.3%, mediastinal gas was 100% (type II). 24/40 cases of bacteria/fungi were isolated (60%). Common Gram(+) bacteria Streptococcus species (44%) Enterococcus faecalis (24%), Common Gram (-) Acinetobacter Baumanii (24%), Klebsiella pneumonie (12%), Pseudomonas aeruginosa (8%). Fungis was isolated 6/24, accounted for 25%. Conclusion: Descending Necrotizing Mediastinitis caused by esophageal perforation is a serious infectious complication and result in life threatening, therefore it should be diagnosed early to have a timely response. Research on characterics of clinical and para-clinical through typical clinical signs, diagntic imaging as well as bacteria helps to make early and appropriate treatment strategies.