Descending necrotizing mediastinitis: Management and controversies

Abstract

Background: Descending necrotizing mediastinitis has been known to be a life-threatening condition. It is most likely to be lethal without a prompt diagnosis and aggressive surgical management. In the surgical management of this subset of mediastinitis, a debate remains as to whether a transthoracic incision should be mandatory in addition to cervical approach. Methods: This is a single-center retrospective study performed at Cipto Mangunkusumo Hospital from January 2012 to June 2014. Patients with descending necrotizing mediastinitis were treated with broad-spectrum antibiotics and with cervical and transthoracic approach (via sternotomy) surgical debridement. Results: There were 16 consecutive cases of descending necrotizing mediastinitis. One patient did not undergo sternotomy and was ruled out from the study. The mean intensive care unit stay was 26.4 days, with a mean hospital stay of 46.7 days. There were three mortality cases reported and a total of three cases that needed reoperation. There was neither post-operative sternal dehiscence nor osteomyelitis found. Conclusion: Considering there are no post-operative sternal-related infection reported in this study, sternotomy should be considered as an access in descending necrotizing mediastinitis management. In the three mortality cases reported, two patients came with preoperative sepsis and one had iatrogenic subclavian artery injury.

Descending necrotizing mediastinitis: key points to reduce the high associated mortality in a consecutive case series

“…If mediastinitis is suspected, a CT scan, including the thorax, may help diagnosis and treatment decision-making. In our series, the mean delay between onset of symptoms and hospitalization was 7 days, which is similar to the published in the literature ( 21 , 22 ).…”

“…Nevertheless, no definitive surgical treatment procedure has yet been established. While some authors advocate a relatively conservative approach (with and without DNM involving the anterior and/or the posterior mediastinum) with only a limited debridement via cervicotomy plus a transcervical drainage of the infection (including a video-mediastinoscopic approach and insertion of mediastinal and intercostal chest drains) ( 23 - 27 ), others authors clearly support a more aggressive approach consisting of a combination of cervical drainage plus a radical surgical debridement of the mediastinum via thoracotomy or videothoracoscopy if the infection extends to the lower mediastinum ( 6 , 9 , 11 , 19 , 22 , 28 - 33 ).…”

Abses Submandibula

“…Healthy Tadulako Journal (Jurnal Kesehatan Tadulako) / Vol 9 No.2 Mei 2023 terbentuknya aneurisma yang sewaktu-waktu dapat ruptur. Pada vena jugularis interna dapat terjadi tromboflebitis vena yang disebut lemmiere syndrome 5,14,21 . Infeksi juga dapat menyebar melalui pembuluh darah ke rongga intrakranial menyebabkan abses cerebri, meningitis, epidural dan subdural empyema, serta ke seluruh tubuh menyebabkan kondisi sepsis 3,12,22 .…”

“…Infeksi juga dapat menyebar melalui pembuluh darah ke rongga intrakranial menyebabkan abses cerebri, meningitis, epidural dan subdural empyema, serta ke seluruh tubuh menyebabkan kondisi sepsis 3,12,22 . Penyebaran infeksi ke daerah retrofaring dapat berlanjut turun menyebabkan obstruksi jalan napas, mediastinitis, pericarditis, dan empyema pleura 14,21 .…”

Đặc điểm lâm sàng và cận lâm sàng áp xe trung thất do thủng thực quản điều trị tại Bệnh viện Hữu nghị Việt Đức

“…Hầu hết các nghiên cứu của tác giả nước ngoài như Muhamad AP và cộng sự [6], cho thấy nguyên nhân thủng TQ do can thiệp y tế chiếm tới 70%. Nhưng trong nghiên cứu của chúng tôi, nguyên nhân hàng đầu chấn thương chiếm 70%, đặc biệt nguyên nhân hóc xương chiếm 88,5%.…”