深頸部膿瘍を併発した食道壁内膿瘍例

抄録

Deep neck abscess is a life-threatening complication of odontogenic and oropharyngeal infections that can progress to descending necrotizing mediastinitis. On the other hand, phlegmonous pharyngo-esophagitis is very rare, with only a very few reports in the literature. Therefore, this disease is difficult to diagnose definitively, and no method of treatment has been established yet.

Herein, we present a case of phlegmonous pharyngo-esophagitis complicated by a deep neck abscess that was managed by systemic antibiotic treatment and surgical intervention on two occasions.

The subject was a male aged 68 years old, who was admitted to our hospital complaining of sore throat and pain on swallowing. Computed tomography (CT) revealed thickening of the hypopharyngeal and esophageal walls, with an intramural low-density area. After intravenous broad-spectrum antibiotic treatment, a drainage procedure was accomplished: open dissection of the neck via video-assisted thoracic surgery. However, due to persistence of the CT findings and elevation of the serum C-reactive protein level, a secondary surgical intervention was executed via a mediastinoscope; this led to successful discharge of pus from inside the esophageal wall.

The treatment strategy for phlegmonous pharyngo-esophagitis should include systemic antibiotic treatment, appropriate surgical drainage and adequate supportive care.