Descending Necrotizing Mediastinitis in Healthy Young Adults: The Fatal Consequence of the Delayed Help
Petar Uchikov,
Maria Kraeva,
Krasimir Kraev,
Bozhidar Hristov,
Dzhevdet Chakarov,
Nedzhat Ali,
Chavdar Stefanov,
Angelina Mollova-Kyosebekirova,
Tihomir Tenchev,
Snezhanka Dragusheva,
Elizabet Dzhambazova,
Bistra Dobreva-Yatseva
Affiliations
Petar Uchikov
Department of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
Maria Kraeva
Department of Otorhynolaryngology, Medical Faculty, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
Krasimir Kraev
Department of Propedeutics of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
Bozhidar Hristov
Section “Gastroenterology”, Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
Dzhevdet Chakarov
Department of Propedeutics of Surgical Diseases, Section of General Surgery, Faculty of Medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
Nedzhat Ali
Department of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
Chavdar Stefanov
Department of Anaesthesiology, Emergency and Intensive Care Medicine, Medical Faculty, Medical University of Plovdiv, Plovdiv 4000, Bulgaria
Angelina Mollova-Kyosebekirova
Department of General and Clinical Pathology, Faculty of Medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
Tihomir Tenchev
Department of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
Snezhanka Dragusheva
Department of Nursing Care, Faculty of Public Health, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
Elizabet Dzhambazova
Faculty of Public Health, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
Bistra Dobreva-Yatseva
Section “Cardiology”, First Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
Introduction: Descending necrotizing mediastinitis is one of the most lethal forms of acute mediastinitis. It originates from an odontogenic or deep neck infection, which descends to the mediastinum through the fascial planes. It is a rare condition, but mortality rates remain high, especially in the presence of comorbidities or predisposing factors. Delay in diagnosis has been shown to be one of the most important factors for the disease outcome. Therefore, early diagnosis and treatment by a multidisciplinary team are of utmost importance. Case series: Four healthy young males with descending necrotizing mediastinitis were treated at our institution. None of them had any comorbidities, but all of them waited between 3 and 4 days before seeking medical help. Upon their arrival at the hospital, in addition to the presence of a severe neck infection, the presence of mediastinitis was also found. Despite the timely surgical treatment of both the source of the infection and the mediastinitis, three of the four cases had a fatal outcome. Conclusion: We believe that the time factor is of greater importance for the outcome of acute descending mediastinitis than the factors of age and presence of accompanying diseases. Proper and rapid treatment by a multidisciplinary team is essential, even for young and healthy people.
