Deep neck abscesses occur as a result of spread of infection from the soft tissues to spaces in the head and neck, and can progress to descending necrotizing mediastinitis (DNM). DNM is a serious condition with a high mortality. A case of deep neck infection complicating DNM is described in the present report.
The patient was a 55-year-old woman who visited a nearby otolaryngologist complaining of a 3-day history of gradually worsening sore throat. Physical examination revealed swelling of the posterior wall of the pharynx, and retropharyngeal abscess was suspected.
The patient was referred to our department for further examination and treatment. Computed tomography revealed abscess formation mainly in the retropharyngeal space. Despite treatment with antibiotics, the abscess worsened and progressed to DNM. Surgical drainage of the neck and thoracic cavity was performed twice. Because the DNM failed to improve even after the surgical drainage, negative pressure wound therapy with instillation and dwelling (NPWTi-d) was initiated. With the NPWTi-d, the abscesses gradually reduced in size, and the patient was discharged from the hospital.
NPWT is a treatment that promotes wound healing by sealing the wound surface and applying continuous negative pressure. In addition to negative pressure, NPWTi-d has an automatic cleaning function, and can be used for wounds with incomplete debridement. NPWTi-d was highly effective in this case, in which the infection continued to progress even after drainage and antibiotic administration. The patient was later diagnosed as having advanced rectal cancer, which was considered as possibly having had an effect on the disease aggravation and intractability. In addition to promoting wound healing, NPWTi-d saves time by obviating the need for frequent dressing. NPWTi-d is considered as a useful treatment for infected wounds that fail to respond to usual treatments such as drainage and antibiotic treatment.
