Acute prevertebral abscess secondary to infected pancreatic pseudocyst

Abstract

We report a case of a middle aged, man with diabetes who presented with dysphagia and odynophagia. On evaluation, he was diagnosed to have an acute prevertebral abscess with an unusual aetiology, an infected pseudocyst of pancreas. Contrast-enhanced CT revealed an enhancing collection in the prevertebral space extending to the retrogastric space and communicating with the body of the pancreas via the oesophageal hiatus. Transoral incision and drainage of the prevertebral abscess were performed. Nasogastric tube was placed in the prevertebral space for continuous drainage and daily irrigation. Supportive intravenous broad spectrum antibiotic therapy along with the surgical intervention led to the resolution of the prevertebral abscess and the infected pancreatic pseudocyst.

Pancreatitis with infected pseudocyst presenting as a prevertebral abscess with spontaneous rupture into the oesophagus

“…Various types of fluid collections occur as a complication of acute pancreatitis (table 1). Although pancreatic pseudocysts extending into the mediastinum via diaphragmatic openings have been documented in case reports,8 9 there is only one reported instance of an infected pseudocyst causing a prevertebral abscess 4. However, rupture of the prevertebral collection into the oesophagus has never previously been reported in the literature.…”

“…Transoral or transthoracic drainage of a prevertebral abscess can be carried out. However, the former runs the risk of fistula formation, which can be prevented using nasogastric tube drainage 4…”

“…Pancreatitis with a pseudocyst causing a prevertebral space abscess is very rare. There has been only one previous case report of an infected pseudocyst of the pancreas presenting as a prevertebral abscess 4. The dagnosis of a prevertebral abscess can be challenging due to the vague presenting features and rarity of neurological deficits 3.…”

Acute prevertebral abscess secondary to intradiscal oxygen–ozone chemonucleolysis for treatment of a cervical disc herniation

“…In developing countries, however, the lack of primary healthcare, antibiotic abuse, and high level of antibiotic-resistant infections have been recognized as prime contributing factors to both deep neck infections and death. 5 Deep neck infections, including prevertebral abscesses, are infections within the potential spaces and fascial planes of the head and neck. Most of these infections are of odontogenic origin.…”