Yu gɛt dis kayn pen na yu chɛst? (Mediastinitis) Lɛ wi lan bɔt am.

Yu dɔn ɛva fil wan strenj pen, ebi, ɔ nɔ fil fayn na di midul pan yu chɛst, usay yu at de? Yu go tink se nɔto siriɔs tin. Bɔt sɔmtɛm, dɛn sayn ya kin bi sayn fɔ se pɔrsin gɛt mɔr siriɔs wɛl bɔdi prɔblɛm. Na dat mek tide wi go tɔk bɔt wan sik we dɛn kɔl `(Mediastinitis)` we kin apin na di chɛst, bɔt we bɔku pipul dɛn nɔ no bɔt. Pan ɔl we dis nem kɔmplikt smɔl, lɛ wi ɔndastand am simpul wan.

Wetin na dis `(Mediastinitis)`?

Fɔ tɔk am simpul wan, `(Mediastinitis)` na inflamɛns ɔ infɛkshɔn we kin apin na di say we dɛn kɔl `(mediastinum)` na di midul pan wi chɛst. Naw yu kin de wɔnda wetin na `(mediastinum)`. imajin, wi chεst na big kכva, we wi kכl `(thoracic cavity)` . na di tu say dεm na dis `(thoracic cavity)` na di `(pleural cavities)` usay wi lכng dεm de. di imכtant spεs we de na di midul pan di chεst, bitwin di tu lכng dεm, dεn kכl am `(mediastinum).`

dis pat pan di `(mediastinum)` na di say we bכku imכtant כgan dεm εn strכkchכ dεm, lεk wi at , pat pan di it paip (`(esophagus)`) , εn di men bכdi vεsul dεm we kכnεkt to di at, de. So yu kin ɔndastand aw i kin siriɔs if inflamɛns ɔ infɛkshɔn apin na dis kayn impɔtant ples. Na dat mek di kɔndishɔn `(Mediastinitis)` kin mek pɔsin in layf de pan denja.

Dis kכndyushכn (Mediastinitis) kin bi akyu (i kin apin wan wan) כ krεse (de divεlכp sכmtεm as tεm de go) .

Wetin kin apin to di bɔdi if yu gɛt `(Mediastinitis)`?

Mediastinitis na wan sik wae de mek pɔrsin in layf de pan denja. Dis inflamɛns kin ambɔg di nɔmal wok we wi impɔtant ɔgan dɛn ɛn blɔd vesel dɛn we de insay di chɛst de wok. Dis kin mek yu gɛt siriɔs prɔblɛm dɛn. So, if yu gɛt tritmɛnt kwik kwik wan, dat kin mek yu gɛt mɔ chans fɔ wɛl ɛn sev yu layf.

Sɔm pan di kɔmplikɛshɔn dɛm we kin apin bikɔs ɔf di mɛdiastinitis na:

• di say we di briz de blok we de mek i nɔ izi fɔ blo.
• k כnstriktiv pεrikarditis (we di mεmbran we de rawnd di at de at).
• Nyumonia we kin kam bak .
• Rayt-sayd at we nɔ de wok fayn .
• Blɔd pɔyzin, dat na `(Sepsis)` .
• Ebi ebi blɔd we de kɔmɔt .
• di supεriכr vena cava sεndrכm (prεshכn pan di supεriכr vena cava, we na wan big vein we de kכri bכdi to di at).

Jɔs tink bɔt, if tin lɛk dis apin, i kin afɛkt di wan ol bɔdi sistɛm. Na dat mek i nɔ fayn fɔ tek dis layt.

Aw dis sik kin kɔmɔn?

Akɔdin to dɔktɔ dɛm, ``Mediastinitis`` na wan sik we nɔ kin apin so ɔltɛm . Bɔt di mak we i kin apin bitwin pipul dɛn (`prevalence`) ɛn udat i kin afɛkt mɔ kin difrɛn difrɛn wan bay di kayn we aw di sik de (`acute` ɔ `chronic`).

Dɛn kin si akyu mɛdiastinaytis as prɔblɛm we kin apin we dɛn du ɔpreshɔn pan in chɛst, mɔ di wan we dɛn kɔl midya stɛnotɔmi . Midian sternotomy na ɔpreshɔn we dɔktɔ kin kɔt yu brɔst bon (sternum) insay tu fɔ mek i go ebul fɔ go na yu at ɔ blɔd vesel dɛn. Bitwin 0.25% ɛn 5% pan di pipul dɛm we de du dis kayn ɔpreshɔn kin gɛt akyu mɛdiastinaytis. Dis rit kin difrɛn frɔm wan ɔspitul to ɔda ɔspitul ɛn frɔm wan rijyɔn to ɔda rijyɔn.

Krεse mεdiastinitis nɔr kin ivin apin. Dɛn kin no am na say dɛn we wan kayn fɔŋ we dɛn kɔl Histoplasma capsulatum kin bɔku (endemic). Bɔt nɔto ɔlman we gɛt dis fɛns kin gɛt dis sik. Risach pipul dεn εstimat se lεs dan 1% pan di wan dεm we dεn kכmכt de gεt fכn infεkshכn (histoplasmosis). Fɔ dɛn wan ya, na smɔl nɔmba nɔmɔ kin gɛt krɛse sik. Stɔdi dɔn sho se bɔku bɔku pipul dɛn stil de na Amɛrika we gɛt fibrosing mediastinitis (wan kayn sik we dɛn kɔl chronic mediastinitis).

Wetin na di difrɛns bitwin `Acute Mediastinitis` ɛn `Kronik Mediastinitis`?

Tu kayn `(Mediastinitis)` de. Wan pan dɛn na `Acute Mediastinitis` . Di ɔda wan na `Kronik Midyastinitis` . Big difrɛns de bitwin dɛn tu tin ya.

Akyu mɛdiastinitis na wan sik we kin apin wantɛm wantɛm, wit bad bad sayn dɛn . fכ egzampl, if pכrforeshכn de na di εsophagus, akyu mεdiastinitis kin divεlכp insay fכ awa. I kin apin bak we infekshɔn de na di trot ɔ yu mɔt. As kɔmplikeshɔn fɔ ɔpreshɔn na in chɛst, i kin apin insay di fɔs mɔnt. Na smɔl tɛm nɔmɔ, i kin apin leta, ivin insay di fɔs ia. Akyu mɛdiastinitis na wan mɛdikal imejensi. Yu fɔ bigin tritmɛnt kwik kwik wan fɔ sev yu layf.

Krɛse mɛdiastinitis na siriɔs sik bak, bɔt i kin kam smɔl smɔl fɔ sɔm mɔnt, sɔm tɛm dɛn kin kam fɔ lɔng tɛm . Dis kin mek di ska tisu dɛn bɔku na yu midiastinum. dis kכndyushכn dεn kכl am fibrosing mediastinitis כ mediastinal fibrosis . Di men tin we kin mek pɔsin gɛt krɛse sik na di fεn infεkshɔn.

Pɔrsin wae gɛt krɛse sik kin nɔr gɛt dis sik fɔ lɔng tɛm, ɔr dɛn nɔr kin gɛt ɛni sayn atɔl. If dɛn gɛt sɔm sayn dɛn lɛk we dɛn nɔ de blo fayn, dɛn kin bigin fɔ fil smɔl ɛn dɛn kin wɔs as tɛm de go. Di sayn dɛm kin apin bikɔs di ska tisu kin gɛda na yu chɛst, we kin prɛs pan yu winda paip (trachea) ɔ di supɛriɔr vena cava, we na wan big vein we kin kɛr blɔd go na yu at. Di tritmɛnt na fɔ ridyus di sayn dɛm ɛn fɔ mek yu layf bɛtɛ.

Wetin na di sayn dɛm fɔ `(Mediastinitis)`?

di simptom dεm kin difrεn bak dipכnt pan if di kכndyushכn na `akyu` כ `krכnik`.

Di simptom dɛm fɔ `Akyu Mediastinitis`:

• Wantɛm wantɛm, bad bad pen na in chɛst.
• Chills we de mek pɔsin kol.
• If yu bin gɛt midyan sternotomy, wan wata we tan lɛk pus kin kɔmɔt na di wund.
• Fiva.
• Shot we yu de blo.

Di simptom dɛm fɔ `Kronik Midyastinitis`:

Krεse mεdiastinitis nɔr kin kɔz ɛni sayn. Bɔt pipul dɛm wae gɛt fibrosing mediastinitis kin gɛt sɔm kayn sik lɛk:

• Chɛst de pen.
• Kɔf, sɔntɛm ivin kɔf blɔd.
• I nɔ kin izi fɔ yu fɔ blo.
• כda simptom dεm we riliyt to ``Superior vena cava syndrome'' (e.g., di fes, nεk, an dεm we de swel).

Wetin na di tin dɛm wae kin mek pɔrsin gɛt `(Mediastinitis)`?

De rizin fɔ dis sik kin difrɛn bak fɔ di kayn sik.

Di tin dɛn we kin mek pɔsin gɛt `Acute Mediastinitis`:

Akyu mɛdiastinaytis kin apin we di tisu dɛn we de insay yu chɛst kin gɛt di sik wantɛm wantɛm. Dɛn infɛkshɔn ya kin kam bikɔs ɔf:

• Di prɔblɛm dɛn we kin apin we pɔsin de du midyan stɛnotɔmi: Bɔku pan di infɛkshɔn dɛn we kin apin afta dis kayn ɔpreshɔn kin kɔmɔt frɔm wan baktri we dɛn kɔl Staphylococcus aureus . Yu chɛst tisu ɔ di wund we dɛn du di ɔpreshɔn kin gɛt di sik we dɛn de du di ɔpreshɔn ɔ jɔs afta dat. Fɔ ɛgzampul, if di wund nɔ wɛl ɔ if jem dɛn go insay di wund.
• di εsophageal perforation: Dis kin apin fכ difrεn rizin dεm. fכ egzampl, komplikashכn dεm we dεn de du εndoskopik prosidכs (εgzamεn dεm we dεn de yuz kεmεra fכ luk insay di εsophagus) כ we yu vכmit pasmak, fכs ( Boerhaave syndrome) kin mek di εsophagus te.
• infεkshכn we de spre frכm di ed כ nεk: dכkta dεn kכl dis ``descending necrotizing mediastinitis.'' Dis min se infεkshכn we bigin na di כp chεst εria de spre dכn insay di chεst, we de pwεl di tisu dεm we de de. Infεkshכn na yu mכt (lεk tut we gεt absεs) εn infεkshכn na yu trot kin spre dis we.

Di tin dɛn we kin mek pɔsin gɛt Kronik Midyastinitis:

Krεse mεdiastinitis na infεkshכn kin kכz am bak. Bɔt if dis kayn tin apin, di inflamɛns na yu tisu dɛn nɔ kin apin wantɛm wantɛm afta yu dɔn gɛt baktri, bɔt i kin apin smɔl smɔl. Krεse mεdiastinitis kin kכz bay:

• Wan fεn infεkshכn (dis na di mכst kכmכn kכz).
• Tubakulosis sik we dɛn kɔl Tuberculosis.
• Redyushɔn tɛrapi.
• Silikosis (na wan sik we de kam pan di lכng we yu inhal di silika patikyula dεm).
• sarkoidosis (di fכmeshכn fכ sכm sכm kכlכsta dεm fכ inflammatory sεl dεm na difrεn כgan dεm na di bכdi).

Sɔntɛnde, dɛn nɔ kin ebul fɔ fɛn ɛni klia kɔz fɔ krɛse mɛdiastinitis. Dɛn kɔl dis idiopathic .

di mכst kכmכn fכn infεkshכn we de mek yu gεt krεse mεdiastinitis na Histoplasma capsulatum . Insay Amɛrika, dis fɛns kin bɔku na di Ohio Riva Vali ɛn di Misisipi Riva Vali. Na ɔda say dɛn na di wɔl, dɛn kin si am na Afrika, Eshia, Ɔstrelia, Sɛntral Amɛrika, ɛn sɔm pat dɛn na Sawt Amɛrika.

Dis fungus de liv na di grɔn. I nɔ bad pas i go insay di ays ɛn yu blo am.Nɔto ɔlman we de pan am go sik. Infakt, bɔrku pipul dɛm wae gɛt dis fungus nɔr go sik atɔl, ɔr go jɔs gɛt smɔl infekshɔn wae nɔr gɛt ɛni sayn. Bɔt, na smɔl chans de fɔ mek yu imyun sistɛm go ɔva riak to dis fɛns afta yu dɔn gɛt am (bɔku tɛm afta sɔm ia). dis kin mek di tisu dεm na yu ``mediastinum'' inflameshn, we kin mek yu gεt kכmplikεshכn.

Wetin na di risk factor dɛm fɔ mek yu gɛt `(Mediastinitis)`?

Naw lɛ wi luk udat kin gɛt dis sik mɔ. If yu de du ɔpreshɔn we nid fɔ du `(median sternotomy)`, lɛk ɔpreshɔn we yu de du fɔ opin at, yu kin wɔri bɔt di prɔblɛm dɛn we kin apin. Tɔk to yu dɔktɔ bɔt di prɔblɛm we yu gɛt. in jεnarכl, yu kin gεt `acute mediastinitis` afta yu gεt `(median sternotomy)` if yu gεt εni wan pan dεn kכndyushכn ya:

• If yu gɛt wan sik we de mek yu imyun sistɛm wik .
• Kronik ɔbstrɔktiv pulmonari sik (COPD) .
• Shuga.
• Kidni we nɔ de wok fayn.
• Fat.
• di pεrifεral atεri sik (PAD) (di bכdi we de na di an εn di lεg dεm de tכn).

Fɔ smok ɛn fɔ smok kin mek bak di risk fɔ gɛt prɔblɛm dɛn afta dɛn dɔn du di ɔpreshɔn.

Sɔm tin dɛn we gɛt fɔ du wit di ɔpreshɔn insɛf kin mek bak di risk fɔ gɛt midiastinitis. Dɛn tin ya na:

• Di ɔpreshɔn tek tu lɔng ɔ di pɔsin bin de pan kadiɔpulmonari baypas fɔ tu lɔng.
• Ri-ɔpareshɔn (if yu dɔn gɛt ɔpreshɔn na yu chɛst bifo).

Yu na `(Histoplasma kapsulatum)`If yu de na say usay di fεnshכn de, yu de pan hεvi risk fכ gεt krεse mεdiastinitis.

Aw dɛn kin no bɔt `(Mediastinitis)`?

Dɔktɔ dɛn kin no if pɔsin gɛt midiastinitis bay we dɛn de chɛk dɛn bɔdi ɛn ɔda tɛst dɛn.

We dɛn de chɛk yu bɔdi, di dɔktɔ go aks yu bɔt:

• Yu simptom dɛm.
• Yu mɛdikal histri (sikin dɛm we yu bin dɔn gɛt bifo, mɛrɛsin, ɛn ɔda tin dɛm).
• Bɔt ɛni ɔpreshɔn ɔ mɛrɛsin we yu dɔn du dis biɛn tɛm .
• Bɔt di eria dɛn we yu dɔn travul go (espɛshali di eria dɛn usay `(Histoplasma capsulatum)` bɔku).

Yu dɔktɔ kin ɔda bak fɔ mek dɛn du ɔda tɛst fɔ no if yu gɛt di sik.

Us tɛst dɛn kin yuz fɔ no if pɔsin gɛt `(Mediastinitis)`?

kɔmpyuta tomografi (CT) skan wit kɔntrast na di gold standad fɔ no if pɔsin gɛt midiastinitis. Apat frɔm dat, yu dɔktɔ kin ɔda fɔ mek dɛn tek ɛkstrem rayt na yu chɛst ɔ fɔ mek dɛn tek nidul bayɔpsi .

Aw dɛn kin trit Mediastinitis?

Wɛl, yu tink se tritmɛnt de fɔ dis? Yɛs, i de. Bɔt i kin difrɛn difrɛn wan fɔ di kayn sik (if na `akyu` ɔ `krɔnik`) ɛn di tin we kin mek i sik.

Akyu mεdiastinitis we de fכlכ mεdian stεrnotomy kin nid dεn tritmεnt dεm ya:

• Antibayɔtik , we dɛn kin gi insay di bɛlɛ (IV) tru wan sɔl sɔlvushɔn.
• Ɔpreshɔn fɔ pul di tisu we dɔn day ɛn pul di wata we dɔn gɛda.

Akyu mεdiastinitis we kin kam we di εsophageal tear kin nid dεn tritmεnt dεm ya:

• Antibayɔtiks.
• Ɔpreshɔn fɔ mek di ol fayn, fɔ pul di tisu we dɔn day, ɛn/ɔ fɔ pul ɛni wata we dɔn gɛda.

If yu gɛt akyu mɛdiastinaytis, yu mɛdikal tim go admit yu na di intensiv kia yunit (ICU) . Na de, di mɛdikal tim go tek tɛm wach yu sik dɛn ɛn aw yu de wɛl.

Di tritmɛnt fɔ di sik we dɛn kɔl kronik mɛdiastinaytis kin inklud ɔpreshɔn fɔ mek dɛn nɔ gɛt di sik. Yu dɔktɔ kin tɛl yu fɔ du tin dɛn we go opin yu aywe ɔ fɔ mek blɔd flɔ fayn fayn wan tru di blɔd vesel dɛn na yu chɛst. Risach pipul dɛm stil de luk fɔ tritmɛnt opshɔn fɔ pipul dɛm wae gɛt krɛse hade.

Tɔk to yu dɔktɔ bɔt di tritmɛnt dɛn we yu go gɛt ɛn wetin yu go ebul fɔ ɛkspɛkt.

Yu tink se dɛn kin ebul fɔ avɔyd Mediastinitis?

I bɛtɛ fɔ mek sɔntin lɛk dis nɔ apin bifo i apin. Mediastinitis na wan kɔmɔn prɔblɛm we kin apin we dɛn de du mɛrɛsin. If yu de du ɔpreshɔn pan yu chɛst ɔ yu de du ɛndoskopik, tɔk to yu dɔktɔ bɔt aw fɔ ridyus yu risk fɔ gɛt prɔblɛm dɛn. Aks wetin yu mɛdikal tim go tek fɔ ridyus yu risk fɔ gɛt di sik. Dɔn bak, mek shɔ se yu aks bɔt aw fɔ kia fɔ yu wund na os afta dɛn dɔn du yu ɔpreshɔn.

Fɔ mek yu nɔ gɛt infɛkshɔn ɛn fɔ trit dɛn jɔs lɛk aw i apin, dat kin ɛp fɔ ridyus di risk fɔ gɛt akyu midiastinitis. Infεkshכn na yu mכt εn trot kin spre to yu chεst εn mek yu gεt siriכs prכblεm. Na sɔm tin dɛm wae yu kin du fɔ ɛp fɔ mek yu nɔr gɛt dɛn kayn sik ya:

• Tek kia gud gud wan fɔ yu tit ɛn yu gam (`(oral hygiene)`) fɔ mek yu nɔ gɛt infɛkshɔn na yu tit.
• Si dɛntist ɛvri siks mɔnt fɔ mek dɛn klin yu tit , ɔ fala wetin yu dɛntist tɛl yu.
• Si dɔktɔ wan tɛm insay di ia fɔ mek dɛn chɛk yu fɔ chɛk yu ɔl wɛlbɔdi.
• If yu gɛt sayn dɛn fɔ se yu gɛt infekshɔn, go to dɔktɔ wantɛm wantɛm , ɛn tek ɛni mɛrɛsin we dɛn tɛl yu fɔ trit di infekshɔn jɔs lɛk aw dɛn tɛl yu.

Yu tink se Mediastinitis kin kil pɔsin?

Dis na siriɔs tin. Yɛs, dis sik kin mek pɔsin in layf de pan denja, we min se i kin kil pɔsin. Fɔ no di sik kwik kwik wan ɛn fɔ trit am na di bɛst we fɔ sev pipul dɛn layf. Lɛ wi tek wan luk pan wetin risach pipul dɛn no bɔt di rit we pipul dɛn kin day pan midiastinitis:

• di mכtalman rεt fכ pipul dεm we de divεlכp akyu mεdiastinitis afta dεn mεdian stεrnotomy de bitwin 1% εn 14% . Dis bεtε pas aw i bin de bifo (12% to 50%). Dis na bikɔs ɔf di impɔtant tin dɛn we dɛn dɔn mek pan di we aw dɛn de du ɔpreshɔn. Yu go de wɔnda wetin mek dɛn rɛnj dɛn ya big so. Dis na bikɔs difrɛn risach stɔdi dɛn de yuz difrɛn pipul dɛn grup fɔ stɔdi di pipul dɛn we de day. So, di tin we go apin to yu go dipen pan bɔku tin dɛn, lɛk usay dɛn du yu ɔpreshɔn, yu ej, ɛn yu ɔl wɛlbɔdi.
• di mכtalman rεt fכ pipul dεm we de divεlכp akyu mεdiastinitis bikoz fכ wan εsophageal tear de difrεn bכku. I dipen pan aw yu kin gɛt tritmɛnt kwik kwik wan. Les dan 10% of pipul dεm wae dεn trit insay 24 awa afta dεn kray de day. Dat nɔmba de go ɔp to 30% to 40% pan di wan dɛn we dɛn trit afta 24 awa. We pɔsin ol, dat kin mek bak di tin we kin apin to am bad bad wan.
• Pipul dεm we gεt ``Descending necrotizing mediastinitis'' kin gεt ``Sepsis'' (blכd pכyzin) kwik kwik wan εn כgan dεm we de fεil. So, di rεt wae de mכtalman de bitwin 11% εn 40% .

Pan ɔl we i tan lɛk se dɛn statystik ya de mek pɔsin fred smɔl, rizin dɛn de fɔ mek wi gɛt op.If yu no bɔt di tin dɛn we kin mek yu gɛt `(Mediastinitis)`, dat go ɛp yu fɔ no ustɛm fɔ go to dɔktɔ if nid de. Dɔn bak, wit di tin dɛn we pipul dɛn de du fɔ mɛn pipul dɛn, ɔpreshɔn de kam fɔ bi sef ɛn dɛn de trit di prɔblɛm dɛn bak.

Ustɛm yu fɔ go to dɔktɔ?

`Acute mediastinitis` na wan kכndyushכn we kin kam wan wan. If yu gɛt sɔm kayn sik lɛk dis (e.g., yu chɛst de pen wantɛm wantɛm, bad bad wan, fiva, i nɔ izi fɔ blo), kɔl 911 wantɛm wantɛm ɔ yu lokal imejensi nɔmba, ɔ go na di ɔspitul we de nia yu. Di kwik we yu gɛt tritmɛnt, na di mɔ yu go wɛl.

Dɔn bak, yu fɔ tɔk to dɔktɔ pan dɛn kayn tin ya:

• If yu de kam fɔ du ɔpreshɔn pan yu at we opin ɔ ɔda mɛrɛsin we go mek yu gɛt mɔ prɔblɛm wit midiastinitis, aks aw yu go ridyus di prɔblɛm we yu gɛt.
• If yu gɛt sayn dɛm fɔ krɛse sik ɔr de wɔri bɔt yu risk.

Fɔ dɔn, mɛsej we yu kin kɛr go na os

Yu go dɔn ɔndastand naw se `(Mediastinitis)` na siriɔs, sɔmtɛm kin mek yu layf de pan denja. Bɔt nɔ panik. Di impɔtant tin na fɔ no bɔt dis.

Mɛmba:

* Afta yu dɔn ɔpreshɔn yu chɛst, mɔ we yu dɔn ɔpreshɔn yu at, tek kia ɔf di wund. Fɔ fala yu dɔktɔ in instrɔkshɔn dɛn di rayt we.

* Nɔ ignore di mɔt ɛn trot infɛkshɔn. Dɛn kin skata ɛn mek bad bad tin dɛn apin.

* If yu gɛt bad bad pen na yu chɛst wantɛm wantɛm, yu gɛt fiva, ɔ yu nɔ ebul fɔ blo , go to dɔktɔ wantɛm wantɛm.

* If yu de na say we fεn lεk `(Histoplasma capsulatum)` de kכmכn, no dat bak.

* Di kwik we dɛn no di sik ɛn trit am, na di mɔ chans fɔ mek i wɛl. We di sayɛns bɔt mɛrɛsin dɔn go bifo, i pɔsibul naw fɔ bia wit dɛn kayn tin dɛn de fayn fayn wan.

If pɔrsin wae yu lɛk gɛt mɛdiastinitis, yu kin fil fɔ wɔri ɛn nɔr kin ebul fɔ ɛp yu. We yu lan bɔt dis sik, dat kin ɛp yu fɔ fil se yu ebul fɔ kɔntrol yusɛf. Dis no go ɛp yu fɔ tɔk to yu pɔrsin wae yu lɛk in mɛdikal tim bɔt wetin de apun. Aks dɛm aw yu go ɛp dɛn as dɛn de wɛl.

` mεdiastinitis, chεst pen, chεst infεkshכn, at כpεrayshכn komplikεshכn, εsophageal pεrforeshכn, fכngal infεkshכn, mεdiastinum