Perforación faringoesofágica espontánea complicada con absceso mediastinal en niño

Abstract

. Introduction: Pharyngo-esophageal perforation represents a critical condition with high morbidity and mortality rates associated with a late diagnosis, current recommendations advocate conservative treatment, this report describes the usefulness of conservative and endoscopic treatment of a patient with spontaneous pharyng-esophageal perforation complicated with mediastinal abscess, the benefit of tissue adhesives in the closure of a residual fístula is detailed and a review of the literature applied to the pediatric population is proposed. Description of the case: A 16-year-old female adolescent who attended the emergency department with dysphagia, fever and subcutaneous emphysema of the neck and thorax, in esophagography and tomography, an upper esophageal perforation and the presence of a mediastinal abscess were corroborated, as the trans endoscopic route was considered insufficient for the patient a drainage of the septate mediastinal cavity and a left posterior cervical approach was decided, allowing mechanical debridement and drainage of 600 ml of purulent material; with clinical improvement, it persists with a pharyngo-cutaneous-mediastinal fístula and the decision was made to instill a solution of tissue adhesive inside the entire double fistulous tract and successful successful closure with a favorable evolution. Conclusions: An early recognition of pharyngoesophageal perforation, as well as aggressive debridement and appropriate drainage, allow tissue adhesives such as cyanoacrylate to promote successful and low morbidity closure by trans endoscopic in secondary sequelae and fistulas.