A Case of Esophageal Perforation with Mediastinitis and a Cervical Subcutaneous Abscess.

Abstract

Esophagealperforation is a serious acute disease. In this paper, a case of esophageal perforation by a fish-bone with severe mediastinitis and a cervical abscess is reported. For a 50-year-old male, the diagnosis was made 15 days after he had swallowed a fish-bone, because the symptoms were slight before severe chest pain began. Two esophageal perforations (19-21 cm and 24-31 cm from his initial tooth line) were confirmed by endoscopy. Moreover, mediastinitis and a huge cervical abscess were recognized perioperatively. Most of his esophagus was resected due to the two long perforations, and mediastinal drainage, cervical esophagostomy and gastrostomy were also performed. After the operation, the patient suffered from a severe pyothorax, but he fortunately recovered. 10 months later, an esophageal reconstraction by gastric tube was done. Since fish-bones sometimes cause esophageal perforations and severe complications are often seen, strict follow-up is needed for patients who accidentally swallow them.