非Clostridium性ガス壊疽による降下性壊死性縦隔炎の1例

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  • DESCENDING NECROTIZING MEDIASTINITIS DUE TO NON-CLOSTRIDIAL GAS GANGRENE-REPORT OF A CASE-

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We successfully treated a case of descending necrotizing mediastinitis (DNM) which was derived from pharyngitis by non-clostridial gas gangrene infection. A 73-year-old woman who developed dyspnea 6 days after throat pain and high fever was transferred to the hospital under endotracheal intubation performed at another hospital. On CT findings which showed gas infiltrated from the neck to anterior mediasinum at another hospital, the patient was diagnosed as gas gangrene. Immediately after admission to the hospital, she underwent an open debridement of the neck, but she gradually DMN. Mediastinal drainage with median sternotomy and access thoracotomy was performed successfully 11 days after the initial drainage of the neck. Then she recovered from DNM and was extubated one month later after mediastinal drainage.<br> Once non-clostridial gas gangrene affects the mediastinum, the prognosis becomes very poor because the anatomy of the organ is so complicated that comes to unsatisfactory mediastinal debridement and drainage. In this case of DNM due to non-clostridial gas gangrene effective mediastinal debridement and drainage with median stemotomy and left second intercostal antethoracotomy might save the life of the patient.

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