Discussion and Conclusions
CT performed before initial incision and drainage of retropharyngeal
abscess showed confinement to the retropharyngeal space (Figure 1).
Following increased pain at the surgical site, repeat imaging showed
extension into the mediastinum from the sagittal, axial, and coronal
angles, respectively (Figures 2-6). Esophagram was performed and showed
no extravasation, although the patient did aspirate (Figure 7). Based
off of the patient history, we postulate that the esophageal perforation
that occurred was a result of an increase in pressure due to patient
activity. According to the patient, she had been yelling at her
significant other for quite some time, with no other voice-related
activity. With no episodes of vomiting or ingestion of a foreign body
recorded prior to the esophageal rupture, combined with a chest x-ray
showing no pneumoperitoneum, Boerrhave’s syndrome was ruled out (Figure
8). Our case we believe is the first study showing a spontaneous
esophageal perforation following an incision and drainage of a
retropharyngeal abscess.