Descending necrotizing mediastinitis after pharyngeal fish bone impaction: a case report.

Descending necrotizing mediastinitis (DNM) is an uncommon but severe complication of deep neck infection. Most cases arise from odontogenic sources, whereas pharyngeal fish bone impaction is rare. We report the case of a 54-year-old man with poorly controlled type 2 diabetes mellitus who developed DNM 10 days after endoscopic removal of a fish bone lodged in the right vallecula. Flexible nasofibroscopy showed a residual vallecular mucosal lesion with marked supraglottic oedema, and contrast-enhanced cervicothoracic CT demonstrated extensive cervical infection with mediastinal spread. The patient underwent emergency cervicotomy with cervical and mediastinal drainage through a cervical approach, followed by broad-spectrum antibiotics, tracheostomy, and intensive care. He improved gradually with multidisciplinary care. This case underscores the need for early recognition, urgent surgical drainage, and coordinated management, especially in patients with poorly controlled diabetes, even after apparently successful foreign body removal.