Successful treatment of descending necrotizing mediastinitis by combining a cervical approach with artificial pneumomediastinum and video-assisted thoracoscopic surgery: a case report.

BACKGROUND: Descending necrotizing mediastinitis (DNM) is a fatal disease that originates from odontogenic, pharyngeal, and cervical infections and spreads to the mediastinum. Although adequate drainage of the neck and mediastinum is important, it may be excessively invasive. We report a case of DNM treated using a cervical approach with artificial pneumomediastinum and video-assisted thoracoscopic surgery (VATS).

CASE PRESENTATION: A 69-year-old male patient who underwent gastrointestinal endoscopy 4 days prior to presentation was referred to our hospital for mediastinal air observed using computed tomography. He was diagnosed with DNM, and an emergency surgery was performed. We created a collar incision and performed drainage and debridement of the cervix. Then, we performed drainage of the retropharyngeal and upper mediastinum by inserting the mediastinoscope through the collar incision and creating artificial pneumomediastinum. Next, drainage of the thoracic cavity was performed during VATS. Subsequently, the abscess resolved, and the patient was discharged on postoperative day 28 without severe complications.

CONCLUSIONS: Surgical drainage using a cervical approach with artificial pneumomediastinum and VATS was useful for treating this case of DNM. This procedure could be a viable option for minimally invasive surgery for DNM.