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Case Reports in Otolaryngology
Volume 2012, Article ID 504219, 4 pages
Case Report

Descending Necrotising Mediastinitis: A Case Report Illustrating a Trend in Conservative Management

1Department of General Surgery, Royal Berkshire Hospital, Reading RG1 5AN, UK
2The West Wing, The John Radcliffe Hospital, Oxford OX3 9DU, UK
3Department of ENT, Royal Berkshire Hospital, Reading RG1 5AN, UK

Received 25 November 2011; Accepted 25 December 2011

Academic Editors: L. J. DiNardo and M. B. Naguib

Copyright © 2012 B. A. P. Jayasekera et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.