Posterior Mediastinotomy as an Unordinary Method of Mediastinal Drainage in Patient with Descending Necrotizing Mediastinitis: A Case Report

Abstract

The authors present a case report of severe descending necrotizing mediastinitis (DNM) of posterior mediastinum, etiologically of vertebral osteomyelitis treated by the drainage through the posterior mediastinotomy. Mediastinitis caused by vertebral osteomyelitis is very rare. The most important diagnostic and surveillance tool for descending mediastinitis is a CT scan of chest and neck. Every surgical approach to the mediastinum has its advantages and disadvantages, so each patient has to be treated individually and the most suitable type of drainage must be chosen. The posterior mediastinotomy is an unusual alternative of drainage of pre- and paravertebrally localized DNM in posterior mediastinum but it is not recommended as a routine strategy.

Keywords

descending necrotizing mediastinitis - posterior mediastinotomy - vertebral osteomyelitis - surgery

• References

• 1 Ewing HP, Hardy ID. The mediastinum. In: Baue AE, Geha AS, Hammond Gl, , et al. Glenn’s Thoracic & Cardiovascular Surgery. Vol. l. 5th ed. Norwalk, CT: Appleton & Lang;; 1991: 584-587
• 2 Freeman RK, Vallières E, Verrier ED, Karmy-Jones R, Wood DE. Descending necrotizing mediastinitis: An analysis of the effects of serial surgical debridement on patient mortality. J Thorac Cardiovasc Surg 2000; 119 (2) 260-267
• 3 Estrera AS, Landay MJ, Grisham JM, Sinn DP, Platt MR. Descending necrotizing mediastinitis. Surg Gynecol Obstet 1983; 157 (6) 545-552
• 4 Casanova J, Bastos P, Barreiros F, Gomes MR. Descending necrotising mediastinitis—successful treatment using a radical approach. Eur J Cardiothorac Surg 1997; 12 (3) 494-496
• 5 Ris HB, Banic A, Furrer M, Caversaccio M, Cerny A, Zbären P. Descending necrotizing mediastinitis: surgical treatment via clamshell approach. Ann Thorac Surg 1996; 62 (6) 1650-1654
• 6 Seybold WD, Johnson III MA, Leary WV. Perforation of the esophagus; an analysis of 50 cases and an account of experimental studies. Surg Clin North Am 1950; 30 (4) 1155-1183
• 7 Isowa N, Yamada T, Kijima T, Hasegawa K, Chihara K. Successful thoracoscopic debridement of descending necrotizing mediastinitis. Ann Thorac Surg 2004; 77 (5) 1834-1837
• 8 Shields TW, LoCicero J, Ponn RB , et al. Posterior mediastinotomy. In: General Thoracic Surgery. 6th ed. Vol. II: The Mediastinum. Lippincott Williams & Wilkins; 2005: 3040