Descending necrotizing mediastinitis due to esophageal perforation

Descending necrotizing mediastinitis due to esophageal perforation Esophageal perforations can result from iatrogenic, spontaneous, or traumatic causes. One serious complication is descending necrotizing mediastinitis (DNM), necessitating urgent intervention. This observational retrospective cohort analysis reviewed four cases of DNM due to esophageal perforation over a 21-year period (January 2002–October 2023) at the Department of Thoracic Surgery, University Hospital of Abderrahman Mami, Ariana, Tunis. The study included four male patients with a median age of 33 +/- 23 years (range: 5-62 years). One patient had diabetes, and one was taking non-steroidal anti-inflammatory drugs. Esophageal perforations were attributed to various causes, including esophageal wall necrosis, diverticulum perforation, candidal esophagitis, and esophageal injury with bone fragment. Bacterial isolates included Streptococcus and E. coli. Common symptoms included malaise and fever. Imaging typically revealed cervical collections extending to the mediastinum with air bubbles. Surgical approaches varied, including cervicotomy, thoracotomy, and cervicotomy with video-thoracoscopic surgery. Treatment involved irrigation, debridement, flattening, and necrosectomy, with one patient requiring an irrigation suction system for 19 days. Median drainage duration was 13 days. Postoperative ICU stay median was 7+/-28 days, with one prolonged stay due to complications. Mortality rate was 50%, with one case requiring re-intervention. Esophageal perforation, though rare, presents significant challenges. Early diagnosis and aggressive management are crucial in reducing mortality rates associated with complications such as DNM.