A Case of Descending Necrotizing Mediastinitis Penetrating to the Esophagus

Abstract

Here, we present the case of a 78-year-old man with a deep neck infection that caused descending necrotizing mediastinitis that extended from the pharynx to the stomach and was accompanied by two large esophageal fistulas and multiple gastric ulcers. We believe that the series of lesions were the signs of a hidden carcinoma.

Deep Neck Infection Complicated by Phlegmonous Esophagitis and Mediastinitis

“…Another case of DNM with esophageal infection has been reported, although a detailed clinical course and response to conservative treatment are not available. 2 Phlegmonous esophagitis is a rare disease and is sometimes fatal, as various complications such as perforation, mediastinitis, pleural inflammation, and empyema can occur. [3][4][5][6][7][8] Consequently, it is difficult to ensure optimal treatment of DNM complicated with phlegmonous esophagitis.…”

“…EGD revealed esophageal perforation, hole, or fistula in some cases. 2,[6][7][8] In 1 of these cases, a mucosal incision was performed using an endoscopic knife to accomplish perfect drainage of the intramural abscess. 4 Therefore, pus drainage intraluminally appears to be essential for curing phlegmonous esophagitis completely.…”

“…1 There is only 1 reported case of phlegmonous esophagitis and mediastinitis following deep neck infection. 2 We describe a case of DNM with phlegmonous esophagitis, successfully treated with surgical and endoscopic procedures.…”