[Descending necrotising mediastinitis - surgical management]. / Descendentní nekrotizující mediastinitida - chirurgická lécba.

ABSTRACT

INTRODUCTION: Descending necrotising mediastinitis (DNM) is a less common form of infection in the mediastinum caused by downward spread from the cervical, oral and pharyngeal regions. MATERIAL AND METHODS: We retrospectively evaluate a group of patients who underwent surgical management of DNM at our department between 2007 and 2011. RESULTS: We operated on 7 patients (1 female, 6 males) with the mean age of 56.3 years. In 3 cases the infection was of odontogenic origin and in 4 cases of tonsillar origin. Except for one patient with permanent immunosuppression, after kidney transplantation, swab culture showed the original, inciting pathogen to be Streptococcus in all cases; as for anaerobic organisms it was mostly Fusobacterium. In all cases we performed external cervical drainage and mediastinal drainage through a cervical approach. In 3 cases it was necessary to perform mediastinal drainage through thoracotomy. Mean hospital stay was 45.7 days, 30-day mortality was zero. CONCLUSION: The results confirm a better prognosis of DNM compared to mediastinitis caused by oesophageal perforation or oesophageal surgery complication.