title: Descending necrotising mediastinitis: a case report illustrating a trend in conservative management.
abstract: The mortality rate from descending necrotising mediastinitis (DNM) has declined since its first description in 1938. The decline in mortality has been attributed to earlier diagnosis by way of contrast-enhanced computed tomographic (CT) scanning and aggressive surgical intervention in the form of transthoracic drainage. We describe a case of DNM with involvement of anterior and posterior mediastinum down to the diaphragm, managed by cervicotomy and transverse cervical drainage with placement of corrugated drains and a pleural chest drain, with a delayed mediastinoscopy and mediastinal drain placement. We advocate a conservative approach with limited debridement and emphasis on drainage of infection in line with published case series.
authors.affiliation: Department of General Surgery, Royal Berkshire Hospital, Reading RG1 5AN, UK.
authors.forename: B A P
authors.initials: BA
authors.lastname: Jayasekera
authors.forename: O T
authors.initials: OT
authors.lastname: Dale
authors.forename: R C
authors.initials: RC
authors.lastname: Corbridge