Mediastinal Gas Gangrene Following Perforation of the Esophagus

Clinical findings:

(1) The patient develops fever, chest pain, and/or hypotension.

(2) A chest X-ray shows gas in the mediastinum and adjacent structures.

(3) There is evidence of an esophageal perforation which may be iatrogenic, traumatic or the result of something swallowed (bone, etc).

(4) Culture shows the presence of a gas-forming bacterium, often anaerobic.

Complications may include:

(1) pleural gas gangrene

(2) sepsis

Management may include:

(1) high dose intravenous antibiotic therapy

(2) resection of devitalized tissue, including esophagectomy

(3) hyperbaric oxygen therapy