Mediastinitis: manejo integral por mínima invasión y lavado mediastinal continuo. Reporte de caso

Abstract

Descending necrotizing mediastinitis is an acute infection at the level of the neck and mediastinum, with a mortality rate of 30 to 67%. The most common etiology is odontogenic infections, accounting for 89% of cases. A 22-year-old patient underwent bilateral lower third molar extraction and presented, seven days later, with swelling in the submandibular region and severe pain at the extraction site that did not respond to analgesics. A CT scan identified peri pharyngeal and pharynx mucosal abscesses, as well as an increased soft tissue volume in the mandibular and anterior cervical regions. Subsequently, an MRI revealed gas bubbles in the prevascular (anterior) mediastinum with altered fat signal intensity, leading to the diagnosis of descending necrotizing mediastinitis. Treatment involved several video-assisted thoracoscopic surgeries (VATS) with the placement of mediastinal drains, and continuous mediastinal irrigation with gentamicin was initiated for five days. Due to the favorable response of the patient, continuous irrigation therapy was concluded. This case report highlights VATS combined with continuous mediastinal lavage as an effective technique for managing mediastinitis, providing the patient with a favorable prognosis.