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Ann Thorac Surg 2000;70:2143-2145
© 2000 The Society of Thoracic Surgeons

Case report

Successful treatment of mediastinal gas gangrene due to esophageal perforation

Jarmo A. Salo, MD, PhDa, Jukka K. Savola, MDa, Vesa J. Toikkanen, MDa, Vesa J. Perhoniemi, MD, PhDa, Ville Y.O. Pettilä, MDb, Jorma A. Klossner, MDc, Hannu J. Toivonen, MD, PhDb

a Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Helsinki, Finland
b Department of Anaesthesiology, Helsinki University Central Hospital, Helsinki, Finland
c Department of Anaesthesiology, Turku University Hospital, Turku, Finland

Accepted for publication February 16, 2000.

Address reprint requests to Dr Salo, Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, FIN-00290 Helsinki, Finland
e-mail: jarmo.salo{at}huch.fi

Esophageal perforation and mediastinal gas gangrene developed in a 55-year-old male after the endoscopic ethanol injection of a Mallory-Weiss ulcer. Initially, extensive gangrene of the esophagus and the mediastinum was treated by esophagectomy; however, an abundance of Clostridium perfringens in the Gram stain verified the presence of gas gangrene. Subsequently, the patient was transferred to a hyperbaric oxygen center, wherein a total of seven hyperbaric treatments were administered. The patient survived, and 4 months later, after having undergone several reoperations because of pleural empyema, mediastinal abscess, splenic rupture, and acalculous cholecystitis, was discharged and is still surviving.






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