[Surgical treatment for patients with descending necrotizing mediastinitis]
S Oka1, T Hanagiri, M Takenaka
1Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
Abstract:
Descending necrotizing mediastinitis (DNM) originating from deep cervical infection is a rare and serious clinical condition with a high mortality rate. Clinical feature of 5 patients undergone surgical drainage for DNM, between 2006 and 2009 were assessed. There were 3 male and 2 female patients whose age ranged from 57 to 83 years old (mean 69.8). All 5 patients had no underlying disease except for 1 patient with severe dental caries. The primary infections of these patients were tonsillitis and pharyngitis. The mean duration from onset of symptom to the referral to our hospital was 14 days (ranged 2 to approximately 41). Two patients underwent cervical drainage for upper mediastinum, and 3 patients were required mediastinal drainage by thoracotomy. There was no post-operative death. Early and aggressive surgical drainage of the neck and mediastinum by a multidisciplinary team of surgeons is very important in the treatment of DNM.
Insights
Descending necrotizing mediastinitis (DNM) is a severe deep cervical infection. Early surgical drainage of the neck and mediastinum is crucial for treating DNM and improving patient outcomes.
Area of Science:
- Infectious Diseases
- Thoracic Surgery
- Critical Care Medicine
Context:
- Descending necrotizing mediastinitis (DNM) is a rare but life-threatening complication of deep cervical infections.
- High mortality rates associated with DNM necessitate prompt and effective treatment strategies.
Purpose:
- To assess the clinical features and outcomes of patients who underwent surgical drainage for DNM.
- To evaluate the efficacy of early and aggressive surgical intervention in managing DNM.
Summary:
- A retrospective review of 5 DNM patients (2006-2009) aged 57-83, with primary infections from tonsillitis/pharyngitis.
- Patients underwent cervical or mediastinal drainage; no post-operative deaths occurred.
- Mean symptom onset to hospital referral was 14 days, highlighting delays in diagnosis and treatment.
Impact:
- Demonstrates that early, aggressive surgical drainage by a multidisciplinary team is vital for DNM treatment.
- Suggests that prompt surgical intervention can significantly reduce mortality associated with this severe infection.
- Highlights the importance of timely referral and intervention for deep cervical infections that may lead to DNM.
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