Descending necrotizing mediastinitis with retroperitoneal extension secondary to oropharyngeal infection
DOI:
https://doi.org/10.32818/reccmi.a11n2a6Keywords:
mediastinitis, deep neck infections, oropharynx, X-ray computed tomography, critical careAbstract
Descending necrotizing mediastinitis is a rare but life-threatening complication of deep cervical infections. We report the case of a 50-year-old man with an oropharyngeal infection complicated by descending necrotizing mediastinitis with exceptional retroperitoneal extension. The patient developed septic shock requiring intensive care unit admission, four multidisciplinary surgical procedures, invasive mechanical ventilation, early tracheostomy, and vasopressor support. Surgical cultures grew Streptococcus anginosus and Prevotella buccae, allowing targeted antimicrobial therapy. Following six weeks of antibiotic treatment and aggressive surgical source control, the patient achieved a favourable clinical outcome. This case highlights the importance of early diagnosis, prompt surgical management, and a multidisciplinary approach.
Downloads
Metrics
References
Reuter TC, Korell V, Pfeiffer J, Ridder GJ, Ketterer MC, Becker C. Descending necrotizing mediastinitis: etiopathogenesis, diagnosis, treatment and long-term consequences-a retrospective follow-up study. Eur Arch Otorhinolaryngol. 2023; 280(4): 1983-90. doi: https://doi.org/10.1007/s00405-022- 07769-x (último acceso ago. 2026). DOI: https://doi.org/10.1007/s00405-022-07769-x
Parjiea CP, Sievert M, Haj Khalaf MA, Ihmsen H, Higaze M, Gehrking M, et al. Management and Outcomes of Descending Necrotizing Mediastinitis: A 15-Year Experience. J Clin Med. 2025; 14(5): 1593. doi: https://doi. org/10.3390/jcm14051593 (último acceso ago. 2026). DOI: https://doi.org/10.3390/jcm14051593
Prado-Calleros HM, Jiménez-Fuentes E, Jiménez-Escobar I. Descending necrotizing mediastinitis: systematic review on its treatment in the last 6 years, 75 years after its description. Head Neck. 2016; 38(Suppl. 1): E2275–E2283. doi: https://doi.org/10.1002/hed.24183 (último acceso ago. 2026). DOI: https://doi.org/10.1002/hed.24183
Guan X, Liang X, Liang X, Wang F, Qian W, Zhang W. A new classification of descending necrotizing mediastinitis and surgical strategies. Ann Transl Med. 2021; 9(4): 356. doi: https://doi.org/10.21037/atm-21-121 (último acceso ago. 2026). DOI: https://doi.org/10.21037/atm-21-121
Venegas Pizarro MDP, Martínez Téllez E, León Vintró X, Quer Agustí M, Trujillo-Reyes JC, Libreros-Niño A, et al. Descending necrotizing mediastinitis: key points to reduce the high associated mortality in a consecutive case series. Mediastinum. 2023; 8: 8. doi: https://doi.org/10.21037/med-23-32 (último acceso ago. 2026). DOI: https://doi.org/10.21037/med-23-32
Ramos-Hinojosa ZI, Álvarez-Maldonado P, Hernández-Ríos G, Hernández- Solís A, Reding-Bernal A, Andrade-Chávez R, et al. Descending necrotizing mediastinitis complicating deep neck abscesses: clinical features and prognostic assessment in 45 ICU patients. Eur Arch Otorhinolaryngol. 2025; 282(5): 2617-25. doi: https://doi.org/10.1007/s00405-024-09179-7 (último acceso ago. 2026). DOI: https://doi.org/10.1007/s00405-024-09179-7
Sugio K, Okamoto T, Maniwa Y, Toh Y, Okada M, Yamashita T, et al. Descending necrotizing mediastinitis and the proposal of a new classification. JTCVS Open. 2021; 8: 633-647. doi: https://doi.org/10.1016/j.xjon.2021.08.001 (último acceso ago. 2026). DOI: https://doi.org/10.1016/j.xjon.2021.08.001
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Juan Antonio Brito-Piris, Pitter Francisco Cueto-Quintana, Ivan Coffin-Barahona, Anna Busquets-Pou
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Permite compartir, copiar y redistribuir el material en cualquier medio o formato, bajo los siguientes términos:
Reconocimiento: debe otorgar el crédito correspondiente, proporcionar un enlace a la licencia e indicar si se realizaron cambios. Puede hacerlo de cualquier manera razonable, pero no de ninguna manera que sugiera que el licenciante lo respalda a usted o su uso.
No comercial: no puede utilizar el material con fines comerciales.
No Derivados: si remezcla, transforma o construye sobre el material, no puede distribuir el material modificado.
Sin restricciones adicionales: no puede aplicar términos legales o medidas tecnológicas que restrinjan legalmente a otros de hacer cualquier cosa que permita la licencia.
