Open window thoracostomy in the treatment of esophageal or bronchopleural fistula with advanced mediastinitis and septic shock

Mediastinitis and septic shock following esophageal or bronchopleural fistula are rare but serious conditions with a high mortality rate. Six patients were treated with open window thoracostomy (OWT) after primary suture repair and closed tube drainage had failed to cure the patient's condition. In all cases the clinical condition improved immediately. Two patients died later because of unrelated diseases. OWT should be considered in critically ill patients with broncho- or esophagopleural fistula when primary therapy fails to control the septic focus.