Infrequent life-threatening complication of descending necrotizing mediastinitis; vertebral artery, internal jugular and subclavian vein rupture

Abstract

We present a case of left proximal vertebral artery (PVA), internal jugular and subclavian vein rupture after descending necrotizing mediastinitis (DNM) initially treated in another surgical institution with antibiotic therapy and left-sided cervicotomy, collar incision and drainage of the left thorax. On day 23 followed by surgical intervention due to the disease propagation, after daily dressing exchange of wound healed on second intention, a life-threatening complication of mixed, massive arterial and venous bleeding developed. The patient was emergency transferred to University Clinic and undergo prompt surgical repair. The jugular and subclavian veins destroyed by suppurative process were sutured. Vein bypass to the PVA was performed. His postoperative course was uneventful and he was discharged home on the 30th postoperative day. We performed the evaluation of DNM-literature review. The articles were collected from 1970 to 2005 (44 reports). Our search did not find any adequate published studies of the relationship between vascular complications described in these case and DNM. We report this case because there have been no previous reports in the literature. © 2007 Surgical Associates Ltd.