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Maiese A, Del Duca F, Ghamlouch A, Treves B, Manetti AC, Napoletano G, De Matteis A, Dimattia F, Wan H, Pignataro L, La Russa R. Sudden Death: A Practical Autopsy Approach to Unexplained Mediastinitis Due to Fatal Untreated Neck Infections-A Systematic Review. Diagnostics (Basel) 2024; 14:1150. [PMID: 38893677 PMCID: PMC11171920 DOI: 10.3390/diagnostics14111150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/21/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Neck infections are often prone to being underestimated and can manifest insidiously. The spread of infection can lead to translocation into thoracic areas, causing descending necrotizing mediastinitis (DNM). However, the application of the post-mortem approach in such cases is not well-described in the literature. A literature review was carried out according to the PRISMA methods. Nine papers were included in the final review, revealing different levels of involvement of neck layers that can be linked to different causes. Expertise with respect to the anatomy of the fasciae and spaces of the neck enables an understanding of the pathogenesis of DNM. However, a clear autoptic description was not provided in any of the articles. Therefore, we also employed a practical post-mortem approach to cases of death due to DNM. It is fundamental for pathologists to identify the exact head and neck structures involved. Providing dissectors with support from an otolaryngologist could be useful. This paper could help address such difficult cases.
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Affiliation(s)
- Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (A.G.); (B.T.); (G.N.)
| | - Alessandro Ghamlouch
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (A.G.); (B.T.); (G.N.)
| | - Biancamaria Treves
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (A.G.); (B.T.); (G.N.)
| | - Alice Chiara Manetti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00161 Rome, Italy; (A.C.M.); (A.D.M.)
| | - Gabriele Napoletano
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (A.G.); (B.T.); (G.N.)
| | - Alessandra De Matteis
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00161 Rome, Italy; (A.C.M.); (A.D.M.)
| | - Francesca Dimattia
- Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Huan Wan
- Criminal Justice School, Zhongnan University of Economics and Law, Wuhan 430073, China;
| | - Lorenzo Pignataro
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy;
- Otolaryngology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Raffaele La Russa
- Department of Clinical Medicine, Public Health, Life Sciences, and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
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Leonardi B, Natale G, Sagnelli C, Marella A, Leone F, Capasso F, Giorgiano NM, Pica DG, Mirra R, Di Filippo V, Messina G, Vicidomini G, Motta G, Massimilla EA, Motta G, Rendina EA, Peritone V, Andreetti C, Fiorelli A, Sica A. Multidisciplinary Management of Descending Necrotizing Mediastinitis: Is Thoracoscopic Treatment Feasible? J Clin Med 2024; 13:2440. [PMID: 38673713 PMCID: PMC11051203 DOI: 10.3390/jcm13082440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/06/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Descending necrotizing mediastinitis (DNM) is a life-threatening condition, generally caused by downward dissemination of oropharyngeal infections through cervical fascial planes. Mediastinal drainage is conventionally achieved by thoracotomy, but a Video-Assisted Thoracoscopic Surgery (VATS) approach is gaining interest due to the reduced invasiveness of procedure. We aimed to evaluate the effectiveness of VATS treatment in patients with DNM. Methods: We conducted a retrospective multicenter study including patients with descending mediastinitis that underwent mediastinal drainage through VATS (VATS group) or thoracotomy (thoracotomy group), both in association with cervical drainage. Patients with mediastinitis secondary to cardiac, pulmonary, or esophageal surgery were excluded. The intergroup differences regarding surgical outcome and postoperative morbidity and mortality were compared. Results: A total of 21 patients were treated for descending mediastinitis during the study period. Cervicotomy and thoracotomy were performed in 15 patients (71%), while cervicotomy and VATS were performed in 6 patients (29%). There were no significant differences in surgical outcome, postoperative morbidity, and mortality between groups. VATS treatment was not associated with a higher complication rate. Patients in the VATS group had a shorter operative time (p = 0.016) and shorter ICU stay (p = 0.026). Conclusions: VATS treatment of DNM is safe and effective. The comparison with thoracotomy showed no significant differences in postoperative morbidity and mortality. The VATS approach is associated with a shorter operative time and ICU stay than thoracotomy.
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Affiliation(s)
- Beatrice Leonardi
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Giovanni Natale
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Antonio Marella
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Francesco Leone
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Francesca Capasso
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Noemi Maria Giorgiano
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Davide Gerardo Pica
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Rosa Mirra
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Vincenzo Di Filippo
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Gaetana Messina
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Giovanni Vicidomini
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Giovanni Motta
- Head and Neck Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.M.); (E.A.M.); (G.M.)
| | - Eva Aurora Massimilla
- Head and Neck Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.M.); (E.A.M.); (G.M.)
| | - Gaetano Motta
- Head and Neck Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.M.); (E.A.M.); (G.M.)
| | - Erino Angelo Rendina
- Thoracic Surgery Unit, Sant’Andrea Hospital, Sapienza University, 00185 Rome, Italy; (E.A.R.); (V.P.); (C.A.)
| | - Valentina Peritone
- Thoracic Surgery Unit, Sant’Andrea Hospital, Sapienza University, 00185 Rome, Italy; (E.A.R.); (V.P.); (C.A.)
| | - Claudio Andreetti
- Thoracic Surgery Unit, Sant’Andrea Hospital, Sapienza University, 00185 Rome, Italy; (E.A.R.); (V.P.); (C.A.)
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Antonello Sica
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
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Marques DL, Rato C, Miguéis A, Miguéis J. Descending necrotising mediastinitis: a rare entity in children. BMJ Case Rep 2024; 17:e258304. [PMID: 38453221 PMCID: PMC10921524 DOI: 10.1136/bcr-2023-258304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
We present a case of descending necrotising mediastinitis (DNM) originating from a retropharyngeal abscess in a healthy early childhood patient. The patient had a history of fever, odynophagia and refusal to eat, followed by rapid deterioration of the clinical state. Cervicothoracic CT was performed, which revealed a right parapharyngeal abscess, extending to the mediastinum and occupying the retropharyngeal/visceral space, with gaseous content throughout this collection, associated with bilateral pleural effusion, aspects compatible with DNM. She started broad-spectrum antibiotic therapy and transoral drainage of the parapharyngeal and retropharyngeal collections was performed under general anaesthesia. She was admitted to the intensive care unit. The patient showed clinical, analytical and imaging improvement, having been transferred to the ear, nose and throat department, with favourable evolution. Early diagnosis of DNM by cervicothoracic CT and multidisciplinary approaches, including intensive care, broad-spectrum antibiotics and surgical intervention, are crucial to minimise the morbidity and mortality.
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Affiliation(s)
| | - Catarina Rato
- Department of Otorhinolaryngology, Coimbra University Hospital Centre, Coimbra, Portugal
| | - António Miguéis
- Department of Otorhinolaryngology, Coimbra University Hospital Centre, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Jorge Miguéis
- Department of Otorhinolaryngology, Coimbra University Hospital Centre, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Zhao Z, Ma D, Xu Y, Guo C, Li S, Wang J, Wang M, Qin Y, Liu H. Surgical therapy and outcome of descending necrotizing mediastinitis in Chinese: a single-center series. Front Med (Lausanne) 2024; 10:1337852. [PMID: 38274461 PMCID: PMC10808615 DOI: 10.3389/fmed.2023.1337852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Background Descending Necrotizing Mediastinitis (DNM) is an acute and often fatal infection that affects the neck and mediastinum. DNM treatment consists of broad-spectrum antibiotics, early diagnosis, and surgical debridement with multidisciplinary cooperation. However, owing to the rarity and complexity of this disease, the mortality rate is high. This retrospective study analyzed a single-center experience of managing DNM in Chinese patients over the last 10 years. Methods A single-center, retrospective, observational, and descriptive study was conducted on 31 patients with DNM at Peking Union Medical College Hospital from 2012 to 2022. Case report forms were used to collect data which were then analyzed with a focus on surgical management and outcomes. Results This study examined the outcomes of 31 patients diagnosed with DNM at our hospital. The most common comorbidities on admission were hypertension (48%) and diabetes mellitus (42%). The degree of diffusion of DNM according to Endo's classification was classified as follows: type I in 7 patients (22.6%), type IIA in 5 (16.1%), and type IIB in 19 patients (61.3%). Among these patients, 13 (41.9%) were found to have a single microbial infection, while 16 (51.6%) were found to have polymicrobial infections. In all cases, neck drainage was performed via cervicotomy, with multiple drains (64.5%) and vacuum sealing drainage (VSD) (35.5%). Mediastinal drainage was performed via a cervical mediastinotomy (51.6%), video-assisted thoracic surgery (VATS) (41.9%), or thoracotomy (6.5%). The 30-day mortality rate was 25.8% and 24.0 days of the average length of hospital stay. Conclusion Early accurate diagnosis and timely intervention have been shown to be correlated with a positive prognosis. Cervicothoracic CT (computed tomography) is essential for the diagnosis, staging, and evaluation of the optimal surgical treatment. Cervicotomy and video-assisted thoracoscopic surgery with percutaneous drainage is effective, even in advanced cases. Additionally, the application of VSD in cervical incision did not improve prognosis but may shorten the length of ICU (intensive care unit) and hospital stays.
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Affiliation(s)
- Zhewei Zhao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dongjie Ma
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Xu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao Guo
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Wang
- Department of ENT, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mu Wang
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yingzhi Qin
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongsheng Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Ranjbar K, Shahriarirad R, Ebrahimi K, Amirian A, Karoobi M, Mardani P, Erfani A, Fallahi MJ, Ketabchi F, Ziaian B. Demographic, clinical, and paraclinical features of patients operated with the diagnosis of acute descending necrotizing mediastinitis: a retrospective study in Southern Iran. J Cardiothorac Surg 2023; 18:354. [PMID: 38066576 PMCID: PMC10704827 DOI: 10.1186/s13019-023-02416-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 11/03/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Descending necrotizing mediastinitis (DNM) is a type of acute mediastinitis that is rarely reported but is regarded as a fatal disease despite improvements in technological methods and antibiotic therapies. We aimed to determine the demographic, clinical, and paraclinical features of patients diagnosed with acute DNM. METHODS In this retrospective study, patients' hospital records with a diagnosis of DNM admitted to the Namazi hospital in southern Iran during 18 years (2002-2019) were reviewed. Demographic and clinical features were recorded and subsequently analyzed via SPSS 22. RESULTS Out of 67 mediastinitis patients, 25 (37.3%) were diagnosed as DNM with an average age of 37.2 ± 16.7 years, and 68% were male. Regarding etiology, 52.0% were due to neck infection. Based on the technique of surgery, 52% of the patients underwent the combined method, which was mostly among type I and IIA DNM, while thoracotomy was mostly performed on type IIB DNM (P = 0.08). Based on the incision, type IIA and IIB had the highest frequency of thoracotomy and cervicothoracic incisions (P = 0.02 and 0.002). Puss discharge was significantly lower in type I DNM (P = 0.01). Based on the presenting symptoms of our patients, the majority (72.0%) had a chief complaint of neck pain, followed by chills and fever (48%). There were no reports of mortality during our short-term follow-up. CONCLUSION We report one of the largest retrospective studies of DNM patients in our referral center, with a high prevalence of the disease among younger populations, especially under 40 years. The method of treatment should be chosen based on the extent of infection and can be limited to neck exploration in upper mediastinal infections, though thoracic or combined approach in more broad infections.
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Affiliation(s)
- Keivan Ranjbar
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamyar Ebrahimi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Amirian
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohamadreza Karoobi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parviz Mardani
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirhossein Erfani
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Javad Fallahi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Ketabchi
- Department of Physiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bizhan Ziaian
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
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Yun JS, Lee CH, Na KJ, Song SY, Oh SG, Jeong IS. Surgical Experience with Descending Necrotizing Mediastinitis: A Retrospective Analysis at a Single Center. J Chest Surg 2023; 56:35-41. [PMID: 36575811 PMCID: PMC9845862 DOI: 10.5090/jcs.22.110] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 12/29/2022] Open
Abstract
Background We analyzed our experience with descending necrotizing mediastinitis (DNM) treatment and investigated the efficacy of video-assisted thoracoscopic surgery (VATS) for mediastinal drainage. Methods This retrospective analysis included patients who underwent surgical drainage for DNM at our hospital from 2005 to 2020. We analyzed patients' baseline characteristics, surgical data, and perioperative outcomes and compared them according to the mediastinal drainage approach among patients with type II DNM. Results Twenty-five patients (male-to-female ratio, 18:7) with a mean age of 54.0±12.9 years were enrolled in this study. The most common infection sources were pharyngeal infections (60%). Most patients had significantly increased white blood cell counts, elevated C-reactive protein levels, and decreased albumin levels on admission. The most common DNM type was type IIB (n=16, 64%), while 5 and 4 patients had types I and IIA, respectively. For mediastinal drainage, the transcervical approach was used in 15 patients and the transthoracic approach (VATS) in 10 patients. The mean length of hospital stay was 26.5±23.8 days, and the postoperative morbidity and in-hospital mortality rates were 24% and 12%, respectively. No statistically significant differences were found among patients with type II DNM between the transcervical and VATS groups. However, the VATS group showed shorter mean antibiotic therapy duration, drainage duration, and hospital stay length than the transcervical group. Conclusion DNM manifested as severe infection requiring long-term inpatient treatment, with a mortality rate of 12%. Thus, active treatment with a multidisciplinary approach is crucial, and mediastinal drainage using VATS is considered relatively safe and effective.
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Affiliation(s)
- Ju Sik Yun
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Cho Hee Lee
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kook Joo Na
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea,Corresponding author Kook Joo Na Tel 82-61-379-7662 Fax 82-61-379-7665 E-mailORCIDhttps://orcid.org/0000-0003-0923-1414
| | - Sang Yun Song
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Sang Gi Oh
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - In Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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