Descending necrotizing mediastinitis (DNM) develops as a complication of an oropharyngeal infection and can be life-threatening. Aggressive therapy is generally advised; usually, treatment consists of cervicomediastinal and transthoracic drainage combined with broad-spectrum antimicrobial therapy, especially when the necrotizing process extends below the level of the fourth thoracic vertebra. A rare case of DNM secondary to a retropharyngeal abscess with fistula to both pleural cavities and to the hypopharynx is reported. The patient was successfully treated by cervicomediastinal surgical drainage and percutaneous drainage of both pleural cavities. In our opinion, even complicated DNM can be treated without aggressive surgery if the patient is in good condition.