A case of submucosal abscess of the esophagus mimicking a mediastinal abscess
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CASE REPORT
A case of submucosal abscess of the esophagus mimicking a mediastinal abscess Hidenori Ojio1 · Yoshihiro Tanaka1 · Yuta Sato1 · Takeharu Imai1 · Naoki Okumura1 · Nobuhisa Matsuhashi1 · Takao Takahashi1 · Kazuhiro Yoshida1 Received: 29 September 2020 / Accepted: 8 November 2020 © Japanese Society of Gastroenterology 2020
Abstract We report a case of a submucosal abscess of the esophagus that required differentiation from a mediastinal abscess. A 48-year-old man presented with a chief complaint of fever and sore throat. He did not remember swallowing a foreign body, and his oral cavity showed no signs of inflammation. Contrast-enhanced computed tomography showed a low density area with enhancement in the mediastinum, especially around the esophageal wall. We planned to perform surgical drainage with the intention of performing intraoperative endoscopy from the beginning. We performed surgical drainage through a left cervical oblique incision; however, there was no exudate obtained from the mediastinal space. Despite the reported absence of accidental ingestion of a foreign substance, intraoperative endoscopy was performed that revealed a laceration in the esophageal mucosa 24 cm from the incisors. We diagnosed it as a submucosal abscess of the esophagus and prescribed parenteral antibiotics. Submucosal abscess of the esophagus can occur even in the absence of awareness of a foreign body ingestion or oral infection. In case that the abscess was not localized clearly within the outer membrane of the esophagus, the coincidental mediastinal drainage via a cervical incision and intraoperative endoscopy seemed to be useful. Keywords Esophageal submucosal abscess · Mediastinal abscess · Surgical drainage · Intraoperative endoscopy
Introduction
Case report
A mediastinal abscess should be drained at the earliest to avoid severe complications [1]. Conversely, submucosal abscess of the esophagus is a rare condition caused by the longitudinal separation of the mucosal and submucosal layers of the esophagus without a perforation [2, 3]. We report a case of submucosal abscess of the esophagus that required differentiation from mediastinal abscess in a patient who did not remember swallowing a foreign body and presented without any inflammation in the oral cavity.
A 48-year-old man presented with a chief complaint of fever and sore throat. His medical history revealed that he suffered from atopic dermatitis. He had previously visited another hospital 3 days after his symptoms had started. Contrastenhanced computed tomography (CT) showed a low density area with enhancement in the mediastinum, especially around the esophageal wall. He was then referred to our hospital on the same day. On admission, his body temperature was 37.8 degrees; blood pressure, 140/93 mmHg; heart rate, 113/min; respiratory rate, 33/min; and SpO2, 95% (room air). Hematological investigations performed on admission revealed that his white blood cell count was 18,000/µl and C-reactive protein (CRP) was 31.3 mg/dl, indicating high levels of
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