Life-threatening tracheal perforation secondary to descending necrotizing mediastinitis.
Survival from destruction of the mediastinal structures secondary to descending necrotizing mediastinitis (DNM) is very rare. We present a successfully treated case of tracheal perforation secondary to DNM. A 34-year-old man with a history of type 1 diabetes mellitus, diagnosed as pharyngeal abscess and subsequent DNM affecting the anterior mediastinum and paratracheal space, was referred to our institute. The patient underwent cervico-mediastinal drainage for DNM. Nine days after the drainage operation, the membranous portion of the trachea perforated, resulting in life-threatening ventilation failure. The patient underwent closure of the fistula with the pedicled intercostal muscle flap under posterolateral thoracotomy with veno-venous extracorporeal membranous oxygenation support. Before complete recovery, open window thoracostomy was required to control residual air leak.
Murakawa
Tomohiro
T
Department of Cardiothoracic Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Yoshida
Yukihiro
Y
Fukami
Takeshi
T
Nakajima
Jun
J
D000038:Abscess / Q000150:complications* / Q000473:pathology / Q000601:surgery; D000328:Adult; D001999:Bronchoscopy; D016638:Critical Illness; D004322:Drainage; D005112:Extracorporeal Circulation; D005402:Fistula / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007366:Intercostal Muscles / Q000601:surgery; D008297:Male; D008480:Mediastinitis / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D009336:Necrosis; D010608:Pharyngeal Diseases / Q000150:complications* / Q000473:pathology / Q000601:surgery; D012121:Respiration, Artificial; D012422:Rupture, Spontaneous; D013524:Surgical Flaps; D013907:Thoracostomy; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D014133:Tracheal Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D014456:Ulcer / Q000209:etiology* / Q000473:pathology / Q000601:surgery