A Case of Descending Necrotizing Mediastinitis Treated with Continuous Saline Irrigation with a Pleated Drain

Abstract

Descending necrotizing mediastinitis (DNM) requires an early and aggressive surgical approach. We report herein on a case of DNM in which continuous saline irrigation with a pleated drain was found to be useful. A 71-year-old man presented with a sore throat and a peritonsillar abscess, CT imaging showed that an abscess with gas had spread widely over the mediastinum. The pus culture showed Streptococcus milleri group, and anaerobic bacteria were not identified in this case, The CT imaging findings on the other hand revealed suspected anaerobic infection and so the conditions in this case had caused serious mixed infection. We performed aggressive therapies such as cervicomediastinal and transthoracic drainage combined with broad-spectrum antimicrobial therapy, but the abscess was not cleared. We therefore added transcervical continuous saline irrigation with a pleated drain. The patient responded well to this treatment and was discharged on the 62 nd postoperative day. We found that continuous saline irrigation with a pleated drain was useful in this case.