Intramural oesophageal abscess: an unusual complication of tonsillitis

Abstract

Tonsillitis is an extremely common condition, usually it is self-limiting, of viral origin, and managed conservatively in general practice. Rarely patients require inpatient management, usually when bacterial infection is present or when the cause is virulent organisms such as Epstein Barr virus. Complications can be divided into non-suppurative; sepsis, scarlet fever, rheumatic fever, glomerulonephritis and Lemierres disease, and suppurative; quinsy, parapharyngeal abscess and retropharyngeal abscess, respectively. Anecdotally, there is concern that modern medical practice that counsels vigilance against overuse of antibiotics, could lead to increased complications of tonsillitis. We report a case of an otherwise healthy man who presented with dysphagia, odynophagia and neck pain following a sore throat. Despite antibiotic treatment he developed an intramural oesophageal abscess, to our knowledge, an unreported complication of tonsillitis.

Keywords: gastrointestinal surgery; general surgery; oesophagus; otolaryngology / ENT.

Figure 1

Contrast CT showing parapharyngeal abscess tracking to retropharyngeal space (arrow). Transverse section of neck.

Figure 2

Contrast CT showing intra-mural oesophageal abscess (arrow). Transverse section lower chest.

Figure 3

Contrast CT showing intra-mural oesophageal abscess (arrow). Coronal section of chest.

Figure 4

Endoscopic view of oesophagus showing true lumen separated from the abscess cavity by a mucosal bridge (arrow).

Figure 5

Mediastinal pleura opened (between stay sutures) into the abscess cavity to allow evacuation of pus.

Figure 6

Full length of abscess cavity opened revealing the oesophageal mucosal tube (M).

Figure 7

Healing oesophageal perforation.