A case of descending necrotizing mediastinitis: Extra-pleural treatment.

AIM

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

KEY WORDS

Descending Necrotizing Mediastinitis, Emergency Surgery.