Deep Neck Infection Complicated by Phlegmonous Esophagitis and Mediastinitis

Descending necrotizing mediastinitis is a life-threatening disease that extends into the pretracheal, perivascular, retrovisceral, and/or prevertebral spaces, generally sparing esophagus. We report case of deep neck abscess complicated by phlegmonous esophagitis and mediastinitis. The patient was successfully treated with antibiotics surgery, combining transcervical bilateral thoracoscopic transthoracic mediastinal drainage. However, pseudo-lumen large amount pus remained in septum between true cut endoscopically, after which recovered well without any complications. Video can be viewed online version this article [10.1016/j.athoracsur.2020.08.101] on http://www.annalsthoracicsurgery.org. (DNM) complication odontogenic or pharyngeal infections, spread along fascial planes, retropharyngeal peritracheal spaces mediastinum.1Sakai T. Matsutani N. Ito K. et al.Deep cervical paratracheal drainage for descending mediastinitis.Asian Cardiovasc Thorac Ann. 2020; 28: 29-32Crossref PubMed Scopus (4) Google Scholar There only 1 reported following infection.2Inaba Y. Tokano H. Ohtsu A. Kitamura A penetrating to esophagus.J Rural Med. 2010; 5: 190-193Crossref describe DNM esophagitis, surgical endoscopic procedures. 61-year-old woman history hypertension glaucoma. One month before admission, small fish bone had lodged her oropharynx. She experienced sore throat, dysphagia, fever, chest pain, 2 days admission. Initial physical examination revealed body temperature 39.2°C, serum results showed marked inflammatory reaction (white blood cell count 13,100/?L C-reactive protein 19.26 mg/dL). Chest radiography enlargement superior mediastinum computed tomography low-density fluid space (Figure 1A), swollen esophageal wall 1B), entire (Figures 1C, 1D). Deep infection diagnosed, empirical antibiotic treatment intravenous doripenem, g every 8 hours, administered. Furthermore, an emergency right tracheostomy performed day admission drained from neck. After 5 days, demonstrated worsening pleural effusion increased intrathoracic 2A, 2B ). At stage, diagnosis DNM, empyema. Video-assisted thoracic surgery debridement cavities 6 (Video). volume slightly muddy evacuated cavity. total mediastinotomy performed, found around upper just above azygos vein. esophagus edematous esophagitis. placing 3 drains cavity, same procedure single tube left Bacterial culture Parvimonas micra, gram-positive anaerobic coccus usually isolated oral Based susceptibility results, changed tazobactam/piperacillin (4.5 hours) clindamycin (300 mg hours). Esophagogastroduodenoscopy (EGD) diffuse erosive mucosa spontaneous intraluminal 3A). Thereafter, gradually recovered, levofloxacin (500 12 started orally 16 instead clindamycin. On 25, repeat EGD absence double lumen 3B). Contrast-enhanced these lumens were compatible intramural dissection 2C). Esophagography confirm lumen. Because about cm length outlet narrow, we serious concerns extra would filled food. Hence, off using dual knife (KD-650Q; Olympus, Tokyo, Japan) 45 3C). Oral ingestion liquids 48 discharged 55. has been year follow up.Figure 2Contrast-enhanced (CT) showing mediastinitis, empyema (A B). (A) Superior (yellow asterisk) arrow). (B) Bilateral enlarged at subcarinal level. Yellow asterisk indicates (C) Reconstructed contrast-enhanced CT image 25 demonstrating false side arrows).View Large Image Figure ViewerDownload Hi-res Download (PPT)Figure 3Esophagogastroduodenoscopy findings. An initial draining through fistula (single yellow asterisk). Double seen 25. (double Endoscopic incision 45. Dual used incision. (D) month. Esophageal epithelium covers lumen.View (PPT) Another reported, although detailed clinical course response conservative are not available.2Inaba Phlegmonous rare sometimes fatal, as various complications such perforation, inflammation, occur.3Mann N.S. Borkar B.B. Mann S.K. associated epiphrenic diverticulum.Am J Gastroenterol. 1978; 70: 510-513PubMed Scholar, 4Wakayama Watanabe Ishizaki al.A gastritis.Am 1994; 89: 804-806PubMed 5Jung C. Choi Y.W. Jeon S.C. Chung W.S. Acute esophagogastritis: radiologic diagnosis.Am Roentgenol. 2003; 180: 862-863Crossref (14) 6Tonouchi Kuwabara S. Furukawa Matsuzawa Kobayashi drainage.Esophagus. 2017; 14: 183-187Crossref (3) 7Huang Y.C. Cheng C.Y. Liao Hsueh Tyan Y.S. Ho S.Y. acute esophagogastritis hypopharyngeal perforation.Am Case Rep. 18: 125-130Crossref 8Woo W.G. Do Lee G.D. S.S. internal feeding jejunostomy.Korean Surg. 50: 453-455Crossref (2) Consequently, it difficult ensure optimal Our underwent urgent drainage, tracheostomy, empiric administration, but continued worsen. Although mediastinotomy, debridement, chest-tube placement effective, improved hole, some cases.2Inaba Scholar,6Tonouchi In cases, mucosal accomplish perfect abscess.4Wakayama Therefore, intraluminally appears essential curing completely. Additionally, decided septa expected possible obstruction food passage, observed cases despite jejunostomy.7Huang Scholar,8Woo infections extending both often fatal. study, very successful video-assisted procedures, less invasive compared external surgeries subtotal esophagectomy Roux-en-Y esophagojejunal anastomosis.4Wakayama authors wish thank all medical doctors, nurses, healthcare workers involved case. https://www.annalsthoracicsurgery.org/cms/asset/8d8f3a7b-e258-43df-b670-cae872c14831/mmc1.mp4Loading ... .mp4 (38.42 MB) Help files Supplemental