Objectives Descending necrotizing mediastinitis (DNM) is a poor prognosis disease. This study aims to examine the patient background and treatment of DNM and to identify more effective treatments for DNM.

Methods The patient background and treatment of 11 patients who underwent surgery for DNM between November 2010 and June 2021 were studied. The patients were divided into six patients who underwent continuous saline irrigation (group I) and five patients who did not (group N). The differences in the drainage duration and length of hospital stay between the two groups were retrospectively investigated.

Results Eleven patients were treated for DNM: six male and five female, with a median age of 61 years (35–79). Comorbidities included diabetes mellitus in three cases; one patient was administered steroids. The pathways of occurrence were anterior tracheal gap/vascular visceral gap/posterior visceral gap in group I (2/1/2) and group N (0/2/4). Progression was I/IIA/IIB according to Endo's classification in group I (1/1/4) and group N (3/1/1). The mean duration of irrigation was 9.0 ± 3.7 days, and the drainage duration in group I was 17.5 ± 8.2 days, which was significantly shorter than 31 ± 13.6 days in group N (p < 0.048). The hospital stays in group I was 29.3 ± 8.4 days, which was significantly shorter than that in group N (68 ± 27.1 days; p < 0.015).

Conclusions Irrigation therapy significantly shortened the drainage duration and hospital stay. Irrigation is a useful treatment for DNM.

A retrospective observational study on the incidence, treatment, and prognosis of descending necrotizing mediastinitis.

Clinical Registration Number 3320.

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Takuya Ohashi was involved in conceptualization, data curation, formal analysis, investigation, methodology, project administration, validation, visualization, and writing, review, and editing—original draft. Mitsumasa Kawago helped in investigation, supervision, validation, and writing, review, and editing—original draft. Takuya Ohashi and Mitsumasa Kawago are co-first authors for this manuscript. Yoshimitsu Hirai, Yumi Yata, Aya Fusamoto, Hideto Iguchi, Takahito Nakaya, Megumi Kiyoi, Miwako Miyasaka, Mari Kawaji, and Yuki Fujiwara contributed to investigation and writing, editing, and review. Yoshiharu Nishimura was involved in investigation, supervision, and writing, editing, and review. All authors critically revised the report, commented on drafts of the manuscript, and approved the final report.

Takuya Ohashi and Mitsumasa Kawago contributed equally to this work

Received: 19 December 2022

Accepted: 28 August 2023

Article published online:
28 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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