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Review
. 2023 Dec 18:24:e942056.
doi: 10.12659/AJCR.942056.

Successful Treatment of Fishbone-Induced Esophageal Perforation and Mediastinal Abscess: A Case Report and Literature Review

Shili Zhong  1 , Zhengbin Wu  1 , Zheng Wang  1
Affiliations
Review

Successful Treatment of Fishbone-Induced Esophageal Perforation and Mediastinal Abscess: A Case Report and Literature Review

Shili Zhong et al. Am J Case Rep. .

Abstract

BACKGROUND Fish bone ingestion is the most common cause of esophageal perforation (12%). However, it rarely causes esophageal perforation and mediastinal abscess. Most studies recommend surgical intervention for patients with esophageal perforation and thoracic abscess. However, surgery may not be suitable for extremely critical cases or may have limited effectiveness. In such cases, a combination of surgery and conservative treatment is crucial. The use of double cannula irrigation and drainage in conservative treatment has shown promising results in pus removal. CASE REPORT We report a 28-year-old man with a perforated esophagus with abscess and mediastinal abscess due to fish bone. Emergency surgery was performed after admission. Symptoms of septic shock developed after surgery, and a significant amount of pus was still present in the chest cavity and mediastinum. Conservative treatment was adopted, with double cannula irrigation and drainage. By employing anti-infection measures and continuous irrigation and drainage, the patient was cured after 42 days. CONCLUSIONS In this case, surgical intervention did not yield satisfactory results. However, after using double cannula irrigation and drainage to clear the thoracic and mediastinal abscesses, the patient's infection levels returned to normal. Additionally, the patient was successfully weaned off the ventilator, and the tracheotomy catheter was removed. After discharge, the patient resumed to normal life, without any significant complications during 1 year of follow-up. Double cannula drainage played a vital role in this patient's treatment; however, further clinical evidence is required to determine its suitability for other patients with esophageal perforation complicated by mediastinal abscess.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1.
Figure 1.
Comparison of chest computed tomography (CT) before and after the patient’s treatment. (A–C) Chest CT of the patient in the Emergency Department. (D, E) Chest CT examination before patient’s discharge. The yellow arrow points to the abscess.
Figure 2.
Figure 2.
Illustration of double cannula drainage in mediastinum and thoracic cavity.
Figure 3.
Figure 3.
Double cannula irrigation and drainage of purulent secretions in the mediastinum.
See this image and copyright information in PMC

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