NCT
HOME CURRENT ARCHIVE COVID-19
HOME CURRENT ARCHIVE PUBLISH INSTRUCTIONS
FOR AUTHORS COVID-19 LOG IN / REGISTER HISTORY ABOUT US DIRECTORY CONTACT
Spontaneous pharyngoesophageal perforation complicated with mediastinal abscess in childrens

Sancho-Hernández, Rogelio1; Solorio-Rodríguez, Lizbeth2; Mascareñas-Martínez, Lourdes1; Castillo-Moguel, José Ariel 1





2020, Number 4

2020; 79 (4)






ABSTRACT

Introduction: Pharyngo-esophageal perforation represents a critical condition with high morbidity and mortality rates associated with a late diagnosis, current recommendations advocate conservative treatment, this report describes the usefulness of conservative and endoscopic treatment of a patient with spontaneous pharyng-esophageal perforation complicated with mediastinal abscess, the benefit of tissue adhesives in the closure of a residual fístula is detailed and a review of the literature applied to the pediatric population is proposed. Description of the case: A 16-year-old female adolescent who attended the emergency department with dysphagia, fever and subcutaneous emphysema of the neck and thorax, in esophagography and tomography, an upper esophageal perforation and the presence of a mediastinal abscess were corroborated, as the trans endoscopic route was considered insufficient for the patient a drainage of the septate mediastinal cavity and a left posterior cervical approach was decided, allowing mechanical debridement and drainage of 600 ml of purulent material; with clinical improvement, it persists with a pharyngo-cutaneous-mediastinal fístula and the decision was made to instill a solution of tissue adhesive inside the entire double fistulous tract and successful successful closure with a favorable evolution. Conclusions: An early recognition of pharyngo-esophageal perforation, as well as aggressive debridement and appropriate drainage, allow tissue adhesives such as cyanoacrylate to promote successful and low morbidity closure by trans endoscopic in secondary sequelae and fistulas.

KEYWORDS

Esophageal perforation, mediastinal abscess, endoscopic treatment, tissue adhesive.

REFERENCES

  1. Zwischengerger JB, Alpard SK, Orringer MB. Esophagus. In: Townsend CM Jr, editor. Sabiston textbook of surgery. 16th ed. Philadelphia: Saunders; 2001. p. 723-727.

  2. Dolgin SR, Wykoff TW, Kumar NR, Maniglia AJ. Conservative medical management of traumatic pharyngeoesophageal perforations. Ann Otol Rhinol Laryngol. 1992;101(3):209-215. https://doi.org/10.1177/000348949210100303.

  3. Wehrmann T, Stergiou N, Vogel B, Riphaus A, Köckerling F, Frenz MB. Endoscopic debridement of paraesophageal, mediastinal abscesses: a prospective case series. Gastrointest Endosc. 2005;62(3):344-349. https://doi.org/10.1016/j.gie.2005.03.001.

  4. White RK, Morris DM. Diagnosis and management of esophageal perforations. Am Surg. 1992;58(2):112-119.

  5. Muir AD, White J, McGuigan JA, McManus KG, Graham AN. Treatment and outcomes of oesophageal perforation in a tertiary referral centre. Eur J Cardiothorac Surg. 2003;23(5):799-804. https://doi.org/10.1016/s1010-7940(03)00050-2.

  6. Abe M, Sugiyama M, Hashimoto Y, Itoh N, Nakaura H, Izumisato Y, et al. Endoscopic nasomediastinal drainage followed by clip application for treatment of delayed esophageal perforation with mediastinitis. Gastrointest Endosc. 2001;54(5):646-648. https://doi.org/10.1067/mge.2001.117155.

  7. Kanshin NN, Pogodina AN. Transesophageal drainage of the mediastinum in perforating mediastinitis. Vestn Khir Im II Grek. 1983;130(2):24-27.

  8. Kahaleh M, Yoshida C, Kane L, Yeaton P. EUS drainage of a mediastinal abscess. Gastrointest Endosc. 2004;60(1):158-160. https://doi.org/10.1016/s0016-5107(04)01310-0.

  9. Eichhorn KWG, Bley TA, Ridder GJ. Undeteced hypopharyngeal perforation with deep neck abscess and mediastinitis due to transesophageal echocardiography. HNO. 2003;51(11):903-907. https://doi.org/10.1007/s00106-003-0809-y

  10. Heater DW, Haskvitz L. Suspected pharyngoesophageal perforation after a difficult intubation: a case report. AANA J. 2005;73(3):185-187.

  11. Salemis NS, Georgiou C, Alogdianakis E, Gourgiotis S, Karalis G. Hypopharyngeal perforation because of blunt neck trauma. Emerg Radiol. 2009;16(1):71-74. https://doi.org/10.1007/s10140-007-0699-5.

  12. Roh JL, Park CI. Spontaneous pharyngeal perforation after forceful vomiting: the difference from classic Boerhaave´s syndrome. Clin Exp Otorhinolaryngol. 2008;1(3):174-176. https://doi.org/10.3342/ceo.2008.1.3.174.

  13. Brinster CJ, Singhal S, Lee L, Marshall MB, Kaiser LR, Kucharczuk JC. Evolving options in the management of esophageal perforation. Ann Thorac Surg. 2004;77(4):1475-1483. https://doi.org/10.1016/j.athoracsur.2003.08.037.

  14. Bjerke HS. Boerhaave´s syndrome and barogenic injuries of the esophagus. Chest Surg Clin N Am. 1994;4(4):819-825.

  15. Younes Z, Johnson DA. The spectrum of spontaneous and iatrogenic esophageal injury: perforations, Mallory-Weiss tears, and hematomas. J Clin Gastroenterol. 1999;29(4):306-317. https://doi.org/10.1097/00004836-199912000-00003.

  16. Gupta NM, Kaman L. Personal management of 57 consecutive patients with esophageal perforation. Am J Surg. 2004;187(1):58-63. https://doi.org/10.1016/j.amjsurg.2002.11.004.

  17. Shaligram A, Dugar N, Capper R. Perforation of cervical oesophagus. J Laryngol Otol. 2005;119(1):51-53. https://doi.org/10.1258/0022215053222987.

  18. Bradham RR, deSaussure C, Lemel AL. Spontaneous perforation of the cervical esophagus. Arch Surg. 1976;111(3):284-285. https://doi.org/10.1001/archsurg.1976.01360210078015.

  19. Agada FO, Dalati MHN, Lee CA, Coatesworth AP, Grace ARH. Spontaneous rupture of the cervical oesophagus following nose blowing: a case report. Int J Clin Pract Suppl. 2005;(147):43-44. https://doi.org/10.1111/j.1742-1241.2004.00270.x.

  20. Fraser ID, Williams GT. Spontaneous rupture of the pharynx. J Laryngol Otol. 1975;89(3):317-322. https://doi.org/10.1017/s0022215100080415.

  21. Wake M, Stansbie M, Thompson H. Spontaneous perforation of the pharynx/esophagus. Ear Nose Throat J. 1991;70(5):318-320.

  22. Kocher GJ, Hoksch B, Caversaccio M, Wiegand J, Schmid RA. Diffuse descending necrotizing mediastinitis: surgical therapy and outcome in a single-centre series. Eur J Cardiothorac Surg. 2012;42(4):e66-72. https://doi.org/10.1093/ejcts/ezs385.

  23. Misthos P, Katsaragakis S, Kakaris S, Theodorou D, Skottis I. Descending necrotizing anterior mediastinitis: analysis of survival and surgical treatment modalities. J Oral Maxillofac Surg. 2007;65(4):635-639. https://doi.org/10.1016/j.joms.2006.06.287.

  24. Prado-Calleros HM, Jiménez-Fuentes E, Jiménez-Escobar I. Descending necrotizing mediastinitis: Systematic review on its treatment in the last 6 years, 75 years after its description. Head Neck. 2016;38 Suppl:E2275-E2283. https://doi.org/10.1002/hed.24183.

  25. Estrera AS, Landay MJ, Grisham JM, Sinn DP, Platt MR. Descending necrotizing mediastinitis. Surg Gynecol Obstet. 1983;157(6):545-552.

  26. Endo S, Murayama F, Hasegawa T, Yamamoto S, Yamaguchi T, Sohara Y, et al. Guideline of surgical management based on diffusion of descending necrotizing mediastinitis. Jpn J Thorac Cardiovascular Surg. 1999;47(1):14-19. https://doi.org/10.1007/bf03217934.

  27. De Freitas RP, Fahy CP, Brooker DS, Primrose WJ, McManus KG, McGuigan JA, et al. Descending necrotising mediastinitis: a safe treatment algorithm. Eur Arch Otorhinolaryngol. 2007;264(2):181-187. https://doi.org/10.1007/s00405-006-0174-z.

  28. Hookey LC, Le Moine O, Deviére J. Successful endoscopic management of a cervical pharyngeal perforation and mediastnal abscess. Gastrointest Endosc. 2005;61(1):158-160. https://doi.org/10.1016/s0016-5107(04)02452-6.

  29. Gobien RP, Stanley JH, Gobien BS, Vujic I, Pass HI. Percutaneous catheter aspiration and drainage of suspected mediastinal abscesses. Radiology. 1984;151(1):69-71. https://doi.org/10.1148/radiology.151.1.6701339.

  30. Arellano RS, Gervais DA, Mueller PR. Computed tomography–guided drainage of mediastinal abscesses: clinical experience with 23 patients. J Vasc Interv Radiol. 2011;22(5):673-677. https://doi.org/10.1016/j.jvir.2011.01.427.

  31. Meranze SG, LeVeen RF, Burke DR, Cope C, McLean GK. Transesophageal drainage of mediastinal abscesses. Radiology. 1987;165(2):395-398. https://doi.org/10.1148/radiology.165.2.3659364.

  32. Shenfine J, Hayes N, Richardson DL, Griffin SM. Combined percutaneous-endoscopic management of a perforated esophagus: a novel technique. Gastrointest Endosc. 2001;54(5):649-651. https://doi.org/10.1067/mge.2001.118718.


2020, Number 4

2020; 79 (4)