Mediastinitis as a complication of a foreign body in the upper third of the esophagus: a case report and literature review

Introduction. Acute mediastinitis accounts for 20–40% of deaths and often occurs due to oropharyngeal abscesses, neck infections, or esophageal foreign bodies. Early diagnosis, optimal treatment strategy, and careful clinical, instrumental, and laboratory monitoring are essential for patient survival.
Objective. To provide a brief review of the literature on the incidence, clinical manifestations, diagnostic, and treatment methods of mediastinitis secondary to esophageal foreign bodies; and to present a clinical case of a foreign body in the upper third of the esophagus with complications such as parapharyngeal abscess and mediastinitis.
Material and methods. To analyze the available literature, a search was conducted in electronic libraries for all time using the keywords “esophageal foreign bodies”, “mediastinitis”, “upper third of the esophagus”. In addition, a notable clinical case of complications of foreign body ingestion in the esophagus was selected from a single-center review of case histories.
Results. The presented case illustrates the development of a parapharyngeal abscess in a 65-year-old man with diabetes mellitus and arterial hypertension after a foreign body (fishbone) ingestion in the upper third of the esophagus (UTE). Due to the low intensity of pain after the event (typical for elderly patients), the patient did not attach importance to the foreign object in the esophagus and three days later was hospitalized in the otolaryngology department, where the abscess was opened. Then the patient received a relatively low dose of antibacterial drugs; after 3 days, against the background of deterioration of the patient’s condition, descending mediastinitis was diagnosed, detected by CT of the mediastinal organs. After mediastentotomy with drainage of the mediastinal space, antibacterial and detoxifying therapy, positive dynamics were obtained.
Conclusion. Insufficiently thorough collection of anamnesis, late CT diagnostics, relatively low doses of antibacterial drugs can cause the development of mediastinitis. At the same time, the likelihood of complications and the recovery process with foreign bodies in the esophagus are affected by the presence of concomitant pathologies and the elderly age of the patient.
Key words: esophageal foreign bodies; mediastinitis; upper third of the esophagus; computed tomography
Conflicts of interest. The authors have no conflicts of interest to declare.
Financing. The paper was done without sponsorship.