[Descending Necrotizing Mediastinitis. Results of Medical-Surgical Treatment in 17 Cases ].

UNLABELLED: Descending necrotizing mediastinitis (DNM) is a serious disease of the mediastinum; early diagnosis and treatment may lower the high mortality rate of this disease.

OBJECTIVE

To know the frequency of DNM in an intensive respiratory care unit.

MATERIAL AND

METHODS

This is a retrospective, transversal, and observational trial of a series of consecutive cases. In a period from January 1, 1990 to December 31, 2000, among 1,560 patients, we found 17 patients with DNM according with selection criteria.

RESULTS

Fifteen males and two females, mean age 38.9 years SD +/- 14.5 years, were studied. In 10, tracheostomy was practiced previously. Seventeen cases had different kinds of previous abscesses, seven periodontal (47%), six retropharyngeal (35.5%), and four (23.5%) submaxillary. All cases were subject to thoracotomy. The most frequent postoperative complications were septic shock in 10 cases (58.8%), eight acute pulmonary damage (47%), six gastrointestinal bleeding (35.6%) and three acute respiratory insufficiency syndrome (11.6%). Seven deaths were registered and 10 patient survived.

CONCLUSIONS

Statistical significance found between survival patients vs those who died was 31.9 +/- 8.6 vs 48.1 +/- 14.1 (p < 0.05) and in those with early tracheostomy 8.0 vs 28.6 (p = 0.68). Death occurred most frequently due to septic shock, specific mortality in this group of patients was 29%. Although DNM is a rare entity, 1.08% of all reviewed cases, must be treated immediately due to high mortality. The importance of early antimicrobial and surgical treatments is stressed.