Buonanno Gennaro Maurizio, Orlando Gennaro Giovanni, Labruna Vittorio, Scarpati Vincenzo Della Vittoria, Perone Mario, Scetta Giovanni Maria, Lanni Veronica Maria
Ann Ital Chir. 2023 Jan 16;12:S2239253X23037581.
Descending necrotising mediastinitis (DNM) is a rare but life-threatening condition. Diagnosis is challenging and prompt treatment is essential. We report a case of DNM in a 44-year-old man.
The patient was hospitalized because of worsening general health after pharyngeal infection, 10 days earlier, and with dyspnea and arrhythmia and suspected sepsis. Echocardiography revealed pericardial effusion. Empirical antibiotic therapy was started immediately. Subsequent evaluation with computed tomography (CT)-scan resulted in a diagnosis of DNM with fluid collections in the lower anterior mediastinum and facilitated surgical planning. The day after, surgery was promptly performed through a vertical epigastric incision permitting effective abscess drainage and debridement of necrotic tissue.
There were no intraoperative or postoperative complications. After 5 days in the Intensive Care Unit, the patient was transferred to the Emergency Surgery Unit. A chest CT-scan on postoperative day 10 showed improvement and the patient was discharged on postoperative day 15.
In a patient with DNM access through a vertical epigastric incision allows mediastinal drainage and debridement,and avoids thoracotomy or thoracoscopy and the related complications.
Descending Necrotizing Mediastinitis, Emergency Surgery.
下行性坏死性纵隔炎（DNM）是一种罕见但危及生命的疾病。诊断具有挑战性，及时治疗至关重要。我们报告一例44岁男性的DNM病例。
患者因10天前咽部感染后全身状况恶化、出现呼吸困难和心律失常以及疑似脓毒症而住院。超声心动图显示心包积液。立即开始经验性抗生素治疗。随后的计算机断层扫描（CT）检查诊断为DNM，下前纵隔有液体积聚，有助于手术规划。次日，通过上腹部垂直切口迅速进行手术，有效引流脓肿并清除坏死组织。
术中及术后均无并发症。在重症监护病房住了5天后，患者转至急诊外科病房。术后第10天的胸部CT扫描显示病情好转，患者于术后第15天出院。
对于DNM患者，通过上腹部垂直切口进行手术可实现纵隔引流和清创，避免开胸手术或胸腔镜手术及相关并发症。
下行性坏死性纵隔炎；急诊手术
