A review of 22 cases of descending necrotizing mediastinitis

Abstract

Descending necrotizing mediastinitis is a severe life-threatening disease with a high mortality rate that requires systemic management, including antibiotics, and prompt and accurate surgical intervention. We present 22 patients (12 men and 10 women) who were treated for descending necrotizing mediastinitis between 2008 and 2019 in our hospital. Their median age was 61 years (range: 41–85 years). Nine patients had diabetes mellitus, but 13 patients did not have an underlying disease causing immunocompromise. Regarding drainage, all patients underwent transcervicotomy. Mediastinal drainage was performed in 2 out of 10 cases of type I, 1 out of 3 cases of type IIA and 7 out of 9 cases of type IIB, all by thoracoscopic drainage. Thoracoscopic mediastinal drainage was considered useful because of its progress-specific approach and the possibility of minimally invasive, appropriately positioned drainage. There were some cases in which initial surgery alone did not result in a cure, and multiple surgical treatments were performed. Appropriate postoperative evaluation using computed tomography with the possibility of reoperation in mind is essential.