Descending necrotizing mediastinitis with esophageal perforation and tracheal ulcer: a case report and literature review

Background Descending necrotizing mediastinitis (DNM) is a rare and life-threatening condition, with high morbidity and mortality. Consequently, appropriate and prompt diagnosis and treatment are necessary. Herein, we report a case of esophageal perforation and bronchial ulcer secondary to DNM, for which thoracoscopic esophagectomy was performed after the failure of conservative treatment. Case presentation A 63-year-old man was diagnosed with mediastinitis affecting the posterior mediastinum after presenting with a sore throat, back pain, and dyspnea. He also had type 2 diabetes mellitus and renal failure. The patient developed septic shock the following day, and intensive treatment was initiated. The condition of the patient gradually improved; however, the laboratory data revealed that levels of C-reactive protein remained high. On day 22, the esophageal perforation was demonstrated on esophagogastroduodenoscopy. Bronchoscopy was remarkable for the ulcer on the membranous tracheal wall, though he did not go into respiratory failure. The emergency thoracoscopic esophagectomy was performed on day 27. The reconstruction surgery was performed on day 100. Conclusions Despite the fact that the general condition is stable with conservative treatment, DNM can develop esophageal perforation. Thus, it is essential to determine the appropriate timing of surgical intervention if levels of inflammation markers continue to be high.