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[Descending necrotic mediastinitis--course and methods of surgical treatment]
Jacek Gawrychowski1, Wojciech Rokicki, Marek Rokicki
1Katedra i Klinika Chirurgii Klatki Piersiowej Slaskiej A.M., Katowice.
Unlabelled:
Between 1995-2002 12 patients, (6 M and 6 F) aged 20-87, (mean 47 years), were treated surgically in our Clinic for descending necrotizing mediastinitis (DNM). The disease was caused by peridental abscess in 7 (54.5%) patients, by peritonsillar abscess in 4 (36.4%), and by retropharyngeal abscess in 1 (9.1%). Septic shock and acute respiratory failure were diagnosed in 11 (91.7%) patients on admission to the Clinic. Complains and clinical symptoms of various intensity appeared during 3-11 days, prior to admission. Extensive cervicotomy and mediastinal drainage were made in 6 patients, whereas cervicotomy and posterolateral thoracotomy in the other 6. Of the 12 patients, 2 (16.7%) survived. Postmortem eximinastions revealed in all patients gangrenous mediastinitis, pericarditis and empyema of both pleural cavities.
Conclusions:
1. No characteristic symptoms and low prevalence are essential causes of problems with proper diagnosis of DNM and related high death rate. 2. Early drainage of neck and mediastinum during thoracotomy should be considered as management of choice in patients with DNM. 3. Symptoms of septic shock, pneumonia, pericarditis or empyema diagnosed on admission to hospital are unfavourable prognostic factors.
Insights
Descending necrotizing mediastinitis (DNM) is difficult to diagnose, leading to high mortality. Early surgical drainage of the neck and mediastinum offers the best management strategy for this severe condition.
Area of Science:
- Thoracic Surgery
- Infectious Diseases
- Critical Care Medicine
Context:
- Descending necrotizing mediastinitis (DNM) is a rare but life-threatening infection.
- It often arises from odontogenic or oropharyngeal infections.
- Prompt diagnosis and aggressive management are crucial for patient survival.
Purpose:
- To review surgical management and outcomes of patients with descending necrotizing mediastinitis.
- To identify factors influencing survival in DNM patients.
Summary:
- A retrospective review of 12 patients with DNM treated surgically between 1995-2002.
- Common causes included peridental (54.5%) and peritonsillar (36.4%) abscesses.
- Most patients presented with septic shock and acute respiratory failure; survival rate was 16.7%.
Impact:
- Highlights the diagnostic challenges and high mortality associated with DNM.
- Emphasizes the critical role of early surgical intervention, specifically cervicotomy and mediastinal drainage, potentially via thoracotomy.
- Identifies severe sepsis, pneumonia, pericarditis, and empyema as indicators of poor prognosis.