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Post-orotracheal intubation tracheal injuries are rare but potentially fatal events. The data in the literature show differences in incidence for single-lumen and double-lumen tube intubations. Esophageal involvement may evolve into mediastinitis with poor prognosis. Treatment depends on the location of the lesion, size, extent and the patient's status. Timing and multidisciplinary team evaluation is mandatory for best decision. In a multi-centric observational study between January 2018 and December 2021 we observed 6 consecutive patients with iatrogenic post oro tracheal intubation tracheo-esophageal laceration underwent to multidisciplinary management. 4 patients were treated with end-to-end tracheal resection and anastomosis and closure of the esophageal fistula with cervicotomy access + interposed muscle flap without esophageal exclusion 1 patient was treated with tracheostomy and anterior fistula repair with cervicotomy access + esophageal exclusion 1 patient was treated conservatively for poor performance status. Surgical treatment was within 12 hours from diagnosis. 30-days mortality was observed in one case. Post-orotracheal intubation tracheal injuries are rare but potentially fatal events. Fast and multidisciplinary decision with aggressive treatment are the goal to improve results and reduce mortality.

Mediastinitis secondary to esophageal perforation is a rare, progressive, and destructive disease that may often lead to an imminent risk of death. We describe a single center experience showing how early diagnosis and prompt intervention can reduce mortality and complications. Methods From February 2016 to December 2019, 15 consecutive patients were referred to the Emergency Unit of The AORN Cardarelli (Naples) with clinical and radiological (CT scan) diagnosis of acute mediastinitis secondary to oesophageal perforation (post endoscopy or after foreign body ingestion) and furthermore, referred to the Thoracic Surgery Unit, they underwent to early surgical treatment (cervicotomy and\or thoracotomy and chest drainage. Results For early detected case (occurred within 24 hours) an emergency thoracotomy/cervicotomy was performed with surgical repair. For late detected (referred from other hospitals) a Surgical esclusion (abdominal plus cervical) and toilette thoracotomy was performed in emergency. Reconstruction occurred in 5 cases with a median of 46 days after firts care. All patient were admitted to ICU unit and susbsequentily to the thoracic surgery ward. 30 days mortality occurred in two cases. Median hospital staying was 28 days, in six cases a redo surgery was necessary. Empiric antibiotic treatment was started before operation and reviewed under Infectivologist. Conclusion Mediastinitis secondary to esophageal perforation has a fulminating course with a potential risk of sepsis, pericarditis, and multiple organ failure. A prompt identification and an invasive treatment is the best and most successful option to reduce mortality and improve patient’s recovery.