Case Presentation
A 49-year-old female, with a history of a retropharyngeal abscess status
post irrigation and drainage on 5/3/20, presented on 5/6/20 to the
emergency department in a large municipal city with increased pain at
the surgical site. A computed tomography (CT) scan showed that the
abscess had worsened, with it now extending into the posterior
mediastinum from the aortic arch to the upper esophageal sphincter. The
patient was taken to the operating room on 5/9/20 by Otolaryngology and
Thoracic Surgery and underwent primary repair of cervical and thoracic
esophageal perforation, sternocleidomastoid muscle flap reinforcement of
the esophageal repair, and cervical and thoracic esophageal myotomy.
Gastroenterology (GI) was also called into the operating room to assist
with an esophagogastroduodenoscopy (EGD), which showed an esophageal
tear 17 cm in length. The patient then had two esophageal stents placed,
as well as a nasogastric tube and G-tube. The patient had an esophagram
on 5/11/20, with no contrast extravasation. However, the patient did
aspirate. The plan is to perform gastro-jejunal (GJ) conversion, per
Interventional Radiology (IR), if no other complications ensue and the
esophagus remains viable.
Her past medical history is significant for depression, schizophrenia,
and nicotine abuse. Cultures of the abscess were taken, showing
positivity for Prevotella bacteremia, and the patient was started on
antibiotics. Otolaryngology, Thoracic Surgery, GI, and Medicine will
continue to follow, with attention being paid to electrolyte replacement
for a previous hyponatremia.