Chirurgia italiana
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The term acute mediastinitis describes a number of clinical conditions, usually secondary to diseases of other aetiology with which they tend to share the severity of the clinical picture. In these situations even a timely diagnosis and adequate therapeutic management are not always enough to ensure healing. Over the period 1987-2002 15 patients with acute mediastinitis were observed (8 male, 7 female), aged from 22 to 90 years (mean age: 57.9), distributed as follows: descending necrotising mediastinitis, 4 cases; iatrogenic oesophageal rupture, 2 cases; iatrogenic tracheal rupture, 3 cases; oesophageal perforation (foreign body), 4 cases; Boerhaave's syndrome, 1 case; oesophageal perforation (lye ingestion), 1 case. ⋯ In 4 cases (2 descending necrotising mediastinitis, 2 acute mediastinitis secondary to oesophageal perforation) repeated interventions were necessary in order to drain pleural or mediastinal effusions. Acute mediastinitis remains a serious clinical entity, the outlook of which is often poor. Factors influencing outcome are the patient's age and general condition (adequate immune response), a timely diagnosis, preoperative localisation of effusions, an aggressive therapeutic approach including drainage of infection sites in the mediastinum, neck and/or pleural cavities, alimentary tract diversion in cases of oesophageal lesions observed late, adequate antibiotic therapy, and nutritional support (total parenteral/enteral nutrition).
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Review Case Reports
[Intestinal occlusion caused by persistent omphalomesenteric duct and Meckel's diverticulum: report of 2 cases].
Two rare cases of mechanical intestinal obstruction due to an omphalomesenteric duct remnant and/or to a Meckel's diverticulum, respectively, are reported. The first case was a 20-year-old man and the second an 87-year-old woman. ⋯ A complete diagnosis was possible only at operation and early surgery was important to prevent strangulation and gangrene of the bowel. The authors conclude that prompt and appropriate surgical treatment reduces the mortality risk in all patients with intestinal obstruction, including even resected cases.