Lessons Learned from the Care of a Retroesophageal Cervical Mediastinal Phlegmon Treated in the Multidisciplinary Surgical Team

The purpose of the paper work. To highlight the severe suppurative cervicomediastinal complications after perforating the cervical esophagus with a sharp foreign body. Objectives of the paper work. To underline the importance of clinical and imagistic diagnosis and the treatment of the cervical medial topographic region with multidisciplinary surgical team: ENT, thoracic surgeon, general surgeon and AIT physician. Materials and method. A 72-year-old patient swallowed a fish bone while eating, with the immediate appearance of a cervical pain with stinging, dysphagia and sore odynophagia. Results and discussion. The patient was hospitalized in emergency 24 hours after the ingestion of the sharp foreign body, presenting with cervical emphysema and leukocytosis 18.000/mm³. CT showed retroesophageal cervical and postero-superior mediastinal collection. The emergency surgical intervention under general anesthesia, with a mixed surgical team, evacuated the purulent collection by antero-inferior cervicotomy, with a drainage aspiration Redon tube, gastrostomy and massive antibiotic treatment for Klebsiella pneumoniae. Daily antiseptic lavage was performed on the aspiration tube for 4 weeks, which led to the suppression of gastrostomy after 6 weeks. Conclusions. The emergency surgery, performed with a multidisciplinary, competent and professional team, has been associated with massive and targeted antibiotic treatment and cervical dressings, performed under septic conditions, and leading to the heal of the cervical mediastinal suppuration.