Successful endoscopic management of a cervical pharyngeal perforation and mediastinal abscess

Abstract

The therapeutic repertoire ofGI endoscopy is expanding rapidly. Perforation of the GI tract remains one of the most serious complications associated with endoscopy. As the use of advanced endoscopic therapeutic procedures is increasing, it is possible that a concurrent increase in the rate of GI perforation will be encountered. Although traditional doctrine states that a perforation of a hollow viscous should be treated surgically, there also has been an ongoing debate for several years regarding conservative management of esophageal perforations. Nonsurgical therapy generally includes administration of broadspectrum antibiotics, elimination of oral intake, parenteral nutrition, and nasogastric drainage. Endoscopic techniques have been added to this list of treatment measures, including placement of drains, clips, and stents. The inherent appeal of such therapy includes avoidance of a laparotomy/thoracotomy, a potential reduction in recovery time, and a possible decrease in peri-operative risks. The present report describes the successful endoscopic/ medical management of an elderly woman with a pharyngeal perforation and a mediastinal abscess as a result of endoscopic treatment of a Zenker’s diverticulum.