Case Presentation
A 49-year-old female with a past medical history significant for
depression, schizophrenia, and nicotine abuse presented with progressive
sore throat and dysphagia for 5 days. Imaging showed a retropharyngeal
fluid collection (Figure 1). She underwent direct laryngoscopy and
cervical esophagoscopy. A sickle knife was used to make an incision in
the posterior pharyngeal wall, but no significant amount of purulence
was released. She was maintained on intravenous antibiotics. She was
discharged 2 days later. Three days after her procedure, she was
presented again to the emergency department with increased neck and
throat pain. A computed tomography (CT) scan showed that the fluid
collection had worsened, with it now extending into the posterior
mediastinum from the postcricoid area of the hypopharynx to the aortic
arch on the sagittal, axial, and coronal angles, respectively (Figures
2-6). The patient was taken to the operating room the following day in a
joint effort by Otolaryngology and Thoracic Surgery. She 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 in an
overlapping fashion (Figures 7 and 8), as well as a nasogastric tube and
G-tube. The patient had an esophagram 2 days later, with no contrast
extravasation. However, the patient did aspirate She used her G tube for
3 weeks. Cultures of the abscess were taken, showing positivity for
Prevotella bacteremia, and the patient was started on antibiotics. She
then had another esophagram which showed no extravasation. She was
allowed to eat orally and was able to do so well. She is doing well with
no issues 5 months after surgery.