Anterior Transmediastinal Drainage in Descending Necrotizing Mediastinitis

Yoshihiro Moriwaki, Kenichi Yoshida, Goro Matsuda, Satoshi Hasegawa, Toshiro Yamamoto, Mitsugi Sugiyama, Yasuhisa Mochizuki^* and Toshimichi Takahashi^*

Department of Critical Care and Emergency Medicine, Yokohama City University, School of Medicine, Yokohama Citizen Medical Center Hospital, Department of Surgery, Yokohama Ekisai-kai Hospital^*

We report a case of descending necrotizing mediastinitis treated by "anterior transmediastinal drainage" providing a good operative field view and excellrent drainage. A 56-year-man with a history of uncontrolled diabetes and chronic hepatitis transferred to our center had been diagnosed with phlegmon of the left anterior chest, neck and mediastinum. We conducted emergency cervical open drainage using a bilateral oblique incision to preserve the skin on the median side for tracheostomy and transcervical mediastinal drainage along the left vascular sheath. A tracheostomy tube was inserted obliquely from the right anterior, and anterior transmediastinal drainage conducted by partially resecting the third rib without thoracotomy directly reaching perivena caval space.

Key words
descending necrotizing mediastinitis, the anterior transmediastinal drainage, the retropharyngeal drainage

Reprint requests
Yoshihiro Moriwaki Department of Critical Care and Emergency Medicine, Yokohama City University, School of Medicine, Yokohama Citizen Medical Center Hospital, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024 JAPAN

Accepted
November 27, 2001

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