Acute mediastinitis in a third-level public hospital in Bogotá city, Colombia: a 6-year retrospective series.

Mediastinitis aguda en un Hospital público de tercer nivel en la ciudad Bogotá, Colombia: Serie retrospectiva de 6 años.

Introduction. Acute mediastinitis is an underdiagnosed entity with diverse clinical results, in addition to having multiple etiologies, among which are post-cardiac surgery, being the most studied and with clearer statistics, others less analyzed such as those caused by esophageal perforation and descending necrotizing mediastinitis, traumatic and idiopathic diseases. We describe the paraclinical findings, management, and prognosis of this entity in a third-level public hospital in the city of Bogotá, Colombia, where specialties such as thoracic surgery, pneumology, and gastroenterology are available.

Materials and methods. We conducted a descriptive observational study with a retrospective search of the medical records of patients diagnosed with acute mediastinitis and related (we ruled out complications from cardiac surgery as an exclusion criterion); Paraclinical variables, etiologies, type of image, microbiology, management, complications, and mortality were described in this group of patients.

Results. 35 subjects in a period of 6 years, the majority were men in 82.9% with an average age of 44 years, the most frequent etiologies were esophageal perforation (PE) with 48.7% (the main cause was foreign body ingestion) and descending necrotizing mediastinitis (DNM) with 45.7% (main trigger was odontogenic abscess with 62.5%); drug dependence was the most frequent comorbidity in 48%; the most frequently performed imagen study was computed tomography in 94.3%, mediastinal edema and emphysema were the main radiological findings, gram-negative bacilli and gram-positive cocci the most found in cultures, surgery being the main management, distributed between cervicotomy and thoracoscopy (VATS) depending on the etiology; overall mortality was 22.9% and the average hospital stay was about 29 days.

Discussions and conclusions. This is one of the largest Colombian studies on this pathology. Because it is performed in a public hospital, various etiologies are obtained. Drug dependence as a prevalent comorbidity associated with poor oral hygiene, it generates odontogenic septic foci as the origin of descending mediastinitis and ingestion of foreign bodies in esophageal perforation with mediastinitis; These findings differ from what has been reported in the world literature, given that by not having an endoscopic intervention service, iatrogenesis was less frequent. Training and skills in minimally invasive management or a multidisciplinary conservative approach have displaced major surgeries performed in the past, our data on hospital stay and mortality are within the range described in world literature.