Management of a difficult infectional disease: Descending necrotizing mediastinitis

  • Fazlı Yanık Faculty of Medicine, Trakya University, Edirne,Turkey
  • Yekta Altemur Karamustafaoğlu Faculty of Medicine, Trakya University, Edirne,Turkey
  • Yener Yoruk Faculty of Medicine, Trakya University, Edirne,Turkey
Keywords: infection, mediastinum, mediastinitis, fatal

Abstract

Introduction: Descending Necrotizing Mediastinitis (DNM) is the fatal form of mediastinitis and mostly develops as a complication of peritonsillar abscesses or dental-odontogenic infections. The aim of this study is to evaluate clinical and surgical feature of the patients with DNM who were managed in our clinic.

Methodology: We retrospectively evaluated 13 consecutive patients with the diagnosis of DNM between February 2005 and February 2018. All of them had the typical physical appearance, history and radiological findings.

Results: Ten (77%) patients were male, 3 (23%) patients were female with a median age of 48.2 (18-76 years). All patients underwent Cervico-Mediastinal Drainage (CMD) with debridement of the necrotic and infected tissues. Other supplimantary surgical procedures were tube thoracostomy (n = 8), VATS mediastinal drainage (n = 4), tracheostomy (n = 2) and thoracatomy (n = 1). The median time to diagnosis of DNM, tube drainage (inserted after CMD) removal time, tube thoracostomy removal time, lenght of hospital stay were 1.8 (range 1-4) days, 13.6 (range 10-20), 12.6 days (range 10-27) and 21.5 days (range 15-30), respectively. Appropriate and potent antibiotics were used according to the fever-CRP response with the consultation on infectious disease specialist. Two patients were lost due to fulminant sepsis (n = 1) and massive cervical haemorrhage (n = 1). Overall mortality rate was 15%. Complications were recorded in 6 patients (46%).

Conclusions: The critical point in the management of DNM is the correct diagnosis, rapid surgical intervention with antibiotherapy and close follow-up for possible complications. We concluded that the combination of minimally invasive management as VATS-tube thoracostomy with CMD is the most appropriate surgical interventions.

Author Biographies

Yekta Altemur Karamustafaoğlu, Faculty of Medicine, Trakya University, Edirne,Turkey

Trakya University Faculty of Medicine Thoracic Surgery Deparment, Edirne,Turkey

Yener Yoruk, Faculty of Medicine, Trakya University, Edirne,Turkey

Trakya University Faculty of Medicine Thoracic Surgery Deparment, Edirne,Turkey

Published
2018-09-30
How to Cite
1.
Yanık F, Karamustafaoğlu Y, Yoruk Y (2018) Management of a difficult infectional disease: Descending necrotizing mediastinitis. J Infect Dev Ctries 12:748-754. doi: https://doi.org/10.3855/jidc.10482
Section
Original Articles