Conservative management of accidental tracheal perforation during surgery for descending necrotizing mediastinitis: a case report and literature review

Survival of tracheal perforation secondary to descending necrotizing mediastinitis (DNM) is very rare, and it is difficult to manage accidental tracheal perforation during DNM surgery. We present a case of a 54-year-old man who had a large tracheal perforation due to DNM, which could not be confirmed preoperatively. A conservative treatment strategy was adopted during surgery to ensure adequate chest drainage. Ultimately, the fistula healed spontaneously, eliminating the need for tracheostomy or additional surgery. Finally, we proposed some suggestions for managing accidental tracheal perforation in this study. Moreover, physicians in primary health care institutions should also increase their awareness of DNM.