Mediastinitis due to Cervical Osteophytes in a Patient after Hemithyroidectomy

Descending necrotising mediastinitis is a terrible disease, usually a complication of an inflammatory process of the pharynx, pathology of the mandibular or submandibular space. The development of mediastinitis in a patient after haemithyroidectomy under general anaesthesia with tracheal intubation due to esophagus injury is a very rare condition. Our patient's early post-operative period was complicated by severe pain behind the sternum not associated with acute coronary syndrome. On the second post-operative day, our suspicions of mediastinitis were not definitively supported by diagnostic tests. On the fourth post-operative day, the patient experienced septic shock, necessitating emergent repeated oesophagogastroduodenoscopy, which located the injury of oesophagus. Emergent torachotomy for mediastinitis, gastrostomy and mediastinal drainage was conducted on the fourth post-operative day. Despite aggressive surgical and critical care management, the patient died 3 days after. Death was caused by mediastinitis complicated by severe sepsis and multiple organ failure. On autopsy, the damage to the posterior wall of the oesophagus occurred as a result of penetrating trauma to cervical and thoracic spine osteophytes during hemithyroidectomy. The pathology section revealed that acute angle osteophytes located at the cervical level injured the oesophagus when the pressure was applied in removing part of the thyroid gland with malignant neoplasia.