Rice Darragh, Fearon Naomi, Reynolds John V, Ravi Narayanasamy
Department of General and Upper GI Surgery, St James Hospital, Dublin, Ireland.
Department of General and Upper GI Surgery, St James Hospital, Dublin, Ireland
BMJ Case Rep. 2021 May 24;14(5):e242145. doi: 10.1136/bcr-2021-242145.
This is a rare case of descending necrotising mediastinitis (DNM) that originated as an oropharyngeal infection, before spreading caudally to include all compartments of the mediastinum and the peritoneum beyond. The mediastinitis was treated early and aggressively with drainage, lavage and debridement in conjunction with broad-spectrum antimicrobial treatment. This case includes a right cervical incision, and a seldom needed surgical laparotomy approach to address the intra-abdominal involvement, and necessity of peritoneal washout. Following a prolonged Intesive Care Unit (ICU) stay and antibiotic course as well as other interventions detailed, the patient made a remarkable recovery and was discharged 101 days post presentation. This report goes on to discuss the rapidly evolving, life-threatening nature of DNM as well as providing an overview of possible management options, outlining how we think such cases should be approached and the clinical suspicion required in a deteriorating patient.
这是一例罕见的下行性坏死性纵隔炎（DNM）病例，该病起源于口咽感染，随后向下蔓延至纵隔的所有间隙以及纵隔以外的腹膜。纵隔炎早期即接受积极治疗，采用引流、灌洗和清创术，并联合使用广谱抗菌药物治疗。该病例包括右侧颈部切口，以及很少需要的手术剖腹术入路，以处理腹腔内受累情况及进行腹腔冲洗的必要性。经过在重症监护病房（ICU）的长时间住院、抗生素疗程以及其他详细的干预措施后，患者恢复显著，并在就诊后101天出院。本报告接着讨论了DNM迅速发展的、危及生命的性质，并概述了可能的治疗选择，阐述了我们认为应如何处理此类病例以及对病情恶化患者所需的临床怀疑。
