Management of Descending Necrotizing Mediastinitis Using Minimally Invasive Video-assisted Thoracoscopic Surgery

Son, Ho Sung; Cho, Jong Ho; Park, Sung Min; Sun, Kyung Hoon; Kim, Kwang Taik; Lee, Sung Ho

doi:10.1097/01.sle.0000213726.72709.62

Cited by 28 publications

(35 citation statements)

References 21 publications

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“…For decades, a lot of authors have approved the significance of CT as the mainstay for early diagnosing of DNM. [11–14] CT scanning is also an accurate and specific tool to direct surgical drainage and monitor postoperative progression. We considered contrast-enhanced CT as the “gold standard” in the diagnosis and evaluation of DNI and DNM.…”

Section: Discussionmentioning

confidence: 99%

Less invasive management of deep neck infection and descending necrotizing mediastinitis

Wei

Bi²,

Zhu³

et al. 2017

Medicine

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By a 7-year retrospective review, we reported our experience in management of descending necrotizing mediastinitis (DNM) and deep neck infection (DNI). A retrospective design was used to reveal the clinical characteristics of DNI and DNM. The clinical outcome was analyzed to validate less invasive management. We reviewed 82 patients between 2009 and 2016, 12 of which were diagnosed as DNM by clinical and computed tomography findings. A total of 35 patients had relevant systemic conditions, mainly diabetes mellitus (19 patients). Most cases were secondary to oropharyngeal or dental infections. All patients underwent transcervical drainage, and 10 DNM patients were treated with additional closed thoracic drainage simultaneously. Twenty patients accepted more than 1 operation. Seven patients died as a result of sepsis and/or multiple organ failure. The mortality rate in our study was similar to that in other studies. In our opinion, less invasive therapies are useful to most patients. Transcervical drainage alone is optimal management for all DNI cases and some DNM cases. Additional closed thoracic drainage is enough for type I and IIA DNM with pleural effusion or empyema.

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Section: Discussionmentioning

confidence: 99%

Less invasive management of deep neck infection and descending necrotizing mediastinitis

Wei

Bi²,

Zhu³

et al. 2017

Medicine

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“…In their series, all patients that underwent both cervicotomy and thoracotomy survived. More recently, less invasive approaches successfully employing thoracoscopic or mediastinoscopic drainage have been reported [11,14,[48][49][50][51][52][53][54][55].…”

Section: Review: Descending Necrotising Mediastinitis E Weaver Et Almentioning

confidence: 99%

Descending necrotising mediastinitis: two case reports and review of the literature

Weaver¹,

Nguyen²,

Brooks³

2010

Eur Respir Rev

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Descending necrotising mediastinitis is a rare and serious infection with a high mortality rate, which complicates pharyngeal or odontogenic infection. Early recognition and treatment are essential in order to minimise morbidity. Evaluation with computed tomography is necessary to confirm the diagnosis and facilitate surgical planning. In addition to prompt empirical antiobiotic therapy, surgical intervention is necessary in nearly all cases. Surgical drainage and debridement may be performed through cervicotomy alone, or through combined cervicotomy and thoracotomy, depending upon the extent of disease. Hyperbaric oxygen therapy may play an auxiliary role. We present two recent cases with characteristic imaging findings, and review the relevant literature. KEYWORDS: Computed tomography, mediastinitis CASE ONEA 60-yr-old male presenting with neck swelling, dysphagia and hoarseness had been extubated 2 days previously following a pneumonia. He had a past medical history of laryngeal cancer treated 10 yrs ago with external beam radiation and chemotherapy. On examination he had bilateral diffuse neck erythema, oedema and right-sided induration. Fibre-optic laryngoscopy showed scabbing of the right hypopharynx and erythematous swelling of the false vocal folds, aryepiglottic folds, and epiglottis. Over the course of 12 h, he developed septic shock with a blood pressure of 70/ 30 mmHg, heart rate of 135 beats?min, and a temperature of 103uF. He was started empirically on vancomycin and piperacillin/tazobactam. After stabilisation in the intensive care unit (ICU), computed tomography (CT) imaging of the neck and chest was performed. There was a large amount of subcutaneous air tracking into the deep fascial planes of the anterior neck, oedematous laryngeal mucosa, and bilateral loculated fluid collections tracking throughout the anterior neck extending to the superior mediastinum ( fig. 1). CT imaging of the chest showed a complex air and fluid collection in the anterior mediastinum extending to the base of the neck ( fig. 2). After review of the images, the patient was taken to the operating room for a combined procedure performed by both head and neck surgeons and thoracic surgeons. Bilateral anterior neck dissections were performed, and blunt dissection, irrigation and debridement were carried out to several centimeters below the sternal manubrium. Penrose drains were left in place. Then, left anterior thoracotomy with debridement of the anterior mediastinum, left pleural decortication and a pericardial window were performed by the thoracic surgeons. Microbiology of the anterior mediastinal fluid grew multiple organisms including Fusobacterium, Prevotella, Bacteroides fragilis, Peptostreptococcus, and a heavy growth of Streptococcus intermedius. Pathology of the pharyngeal lesions showed necrosis and granulation tissue. No neoplasm was identified. The patient later received a tracheostomy and pectoralis myocutaneous flap repair of the neck without sequelae. His total ICU length of stay was 32 days, and hi...

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“…Other reports, documenting the excellent rate of resolution of the infection, without the need for further surgical intervention, have followed. (4,7,12) The postoperative evolution should be rigorously monitored, imaging studies being conducted only when there is suspicion of smaller but septate collections; these collections can and should, whenever possible, be approached by techniques of tomography-guided drainage under local anesthesia, coinciding with the aforementioned concept.…”

Section: Resultsmentioning

confidence: 99%

“…(5) Currently, the incidence of descending necrotizing mediastinitis remains low. However, despite advanced surgical techniques and intensive care, mortality rates remain significant, being as high as 40% in some case series (3,7) Surgical treatment has become a consensus among authors, given the aggressiveness of the infection and its potential for lethality. However, the surgical access for the treatment varies.…”

Section: Discussionmentioning

confidence: 99%

“…The patient was for the treatment of descending necrotizing mediastinitis; the authors of those studies sought to show that cervicotomy combined with videoassisted thoracoscopy allows ample and efficient access to the mediastinum, thereby making it possible to perform mediastinal exploration, debridement, and drainage, which collectively constitute the sine qua non for the treatment of this disease. (4,7,(12)(13)(14) The objective of the present study was to report a case series of patients with descending necrotizing mediastinitis who were satisfactorily treated with minimally invasive thoracic surgery.…”

Section: Introductionmentioning

confidence: 99%

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Mediastinite descendente necrosante: tratamento cirúrgico torácico minimamente invasivo

et al. 2010

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OBJETIVO: Relatar uma série de casos de pacientes com mediastinite descendente necrosante (MDN) tratados com cirurgia torácica minimamente invasiva. MÉTODOS: Relatamos os casos de três pacientes com MDN submetidos à desbridamento mediastinal através de cirurgia torácica videoassistida no Hospital São Paulo, São Paulo (SP), desde a sua admissão até o desfecho final. RESULTADOS: Os três pacientes apresentaram boa evolução pós-operatória, com tempo médio de internação de 16,7 dias. CONCLUSÕES: Concluímos que a videotoracoscopia é uma técnica efetiva para a drenagem mediastinal no tratamento da MDN, com os benefícios da cirurgia minimamente invasiva: menos dor pós-operatória, menor liberação de fatores inflamatórios, retorno precoce às atividades diárias e melhores resultados estéticos.

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Management of Descending Necrotizing Mediastinitis Using Minimally Invasive Video-assisted Thoracoscopic Surgery

Cited by 28 publications

References 21 publications

Less invasive management of deep neck infection and descending necrotizing mediastinitis

Less invasive management of deep neck infection and descending necrotizing mediastinitis

Descending necrotising mediastinitis: two case reports and review of the literature

Mediastinite descendente necrosante: tratamento cirúrgico torácico minimamente invasivo

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