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.