Three Cases of Descending Necrotizing Mediastinitis

Abstract

We have experienced three cases of descending necrotizing mediastinitis (DNM) treated with emergency drainage and intensive care. Case 1 : A 45-year-old man with untreated diabetes mellitus was diagnosed with DNM caused by untreated dental caries. He underwent mediastinal drainage through the cervical and thoracic approach (video-assisted thoracic surgery, VATS). He died of multiple organ failure 3 days after the surgery.

Case 2 : A 36-year-old woman with post-cardiac arrest syndrome was diagnosed with DNM when tracheostomy was performed. She underwent mediastinal drainage through the cervical approach. She was transferred to other institution from our hospital on postoperative day 96 with stenosis of the trachea.

Case 3 : A 48-year-old man was diagnosed with DNM caused by untreated dental caries. He underwent mediastinal drainage three times through the cervical and thoracic (VATS) and subxiphoidal approach. He was discharged on dependent gait from our hospital on postoperative day 106.

With a recent accumulation of clinical cases of DNM, the therapeutic strategies have been clarifying. More efficient transthoracic drainage method for life-threatening DNM cases and a multi professional collaboration for an early return to work are important.