Mediastinoscopic removal of a superior mediastinal foreign body

The safe removal of a superior mediastinal foreign body by mediastinoscopy: a case report

Background

Mediastinal foreign bodies might cause mediastinal organ injury or mediastinal abscess. The prompt removal surgery of mediastinal foreign bodies is needed to prevent those complications. We report a case in which a mediastinal foreign body was removed by video-mediastinoscopy.

Case presentation

The patient, a 74-year-old man with a chief complaint of hoarseness, was referred to our department for surgical management of a wooden foreign body that had traumatically migrated into the superior mediastinum. During the surgery, the video-mediastinoscopy was introduced under the pneumomediastinal pressure. We could dissect the scar tissue and remove the azalea tree branch safely and carefully, without damaging the other mediastinal organs. He was discharged on postoperative day 5, with no complications.

Conclusions

Video-mediastinoscopic approach under pneumomediastinal pressure is minimally invasive and could provide wide surgical view. Therefore, we consider it useful and effective for removal of foreign bodies in the mediastinum.

Video-mediastinoscopy assisted fish bone extraction and superior Medistinal abscess debridement

Background

Mediastinum abscess caused by sharp esophageal foreign body perforation usually needs surgical treatment, and the surgical procedures vary according to size of perforation and scope of abscess, etc. For special case with small esophageal mucosal crevasse and focal abscess confined to mediastinum, minimally invasive surgery with guidance of video-mediastinoscopy would be an alternative method, however, application of video-mediastinoscopy in this life-threatening situation was rarely reported.

Case presentation

One patient with detention of fish bone stuck in the esophagus developed systemic inflammatory response syndrome. Computed tomography results revealed that two high-density foreign bodies migrated extraluminally and caused abscess confined in the mediastinum. Multidisplinary collaborative efforts of anesthesiology, gastroenterology and thoracic surgery were made to optimize the therapeutic process. By taking advantages of wide working channel and better exposure of video-mediastinoscopy, two sharp fish bones were removed with minimal risk of injuring adjacent important tissues, furthermore, complete debridement of the abscess and precise drainage tube indwelling was achieved simultaneously. Postoperative comprehensive therapy including anti-infection and nutrition support guaranteed a smooth transition of perioperative period.

Conclusion

This is the first report on application of video-mediastinoscopy in removing two fish bones that migrated extraluminally and debridement of the abscess caused by esophagus perforation with minimal injury risk, which offer a safe and effective minimal invasive method for specific cases.

Mediastinoscopy as a therapeutic tool

Mediastinoscopy is a safe and effective diagnostic modality to obtain tissue specimens from the anterior mediastinum in most patient lymph node tissue. The technique can also be applied to remove other material from the mediastinum. We describe a case in which a bullet was retrieved from the mediastinum, lying very close to the innominate artery. Important differences in using the device for this purpose are highlighted.