Phlegmonous Esophagitis Research Articles

Optimal Management of Patients with Phlegmonous Esophagitis: A Systematic Review and Meta-Analysis.

To assess the characteristics and prognosis-influencing factors of phlegmonous esophagitis, a rare condition marked by suppurative inflammation of the esophageal submucosa and muscular layers. Effective management strategies for phlegmonous esophagitis are lacking. This study aims to systematically review cases to better understand the disease's features and prognostic determinants. A systematic search was performed using PubMed/MEDLINE and Google Scholar from inception to 20 April 2023. Phlegmonous esophagitis case reports and studies with patient information were included; clinical manifestations, laboratory results, imaging findings, other diagnostic findings, and outcomes were analyzed. A pooled analysis was performed to investigate mortality-related risk factors. A total of 35 cases of phlegmonous esophagitis were selected from 31 case reports and 2 case series (median age, 57.0 years; male, 54.3%). The patients presented various clinical symptoms, with neck-to-epigastric pain and dysphagia being the most common. Comorbid diabetes mellitus was a major predisposing factor; one-third of the patients had no previous medical history. Computed tomography (CT) and endoscopic examinations were predominantly used for phlegmonous esophagitis diagnosis. Radiological findings showed that the upper and middle esophagus were most frequently involved. Treatments included administration of broad-spectrum antibiotics and drainage via endoscopy or surgery. There were three cases of mortality, and non-survivors tended to have shorter hospital stays, indicating rapid disease progression. In logistic regression, thoracic surgery was a significant mortality-related risk factor (odds ratio, 19.30; 95% confidence interval, 1.33-282.00, p = 0.03). Advancements in CT and endoscopy have led to less-invasive diagnostic and treatment methods for phlegmonous esophagitis. Endoscopic localized abscess treatment is associated with positive outcomes.

The Usefulness of Magnetic Resonance Imaging in the Management of Acute Phlegmonous Esophagitis.

Acute phlegmonous esophagitis is a rare life-threatening disease that often requires surgical intervention in case of complications, including esophageal abscess, perforation, or mediastinitis. We present a case of acute phlegmonous esophagitis, in which magnetic resonance imaging (MRI) proved useful in planning the treatment strategy. An 89-year-old woman was admitted to the emergency department with painful swallowing and respiratory distress. She was diagnosed with acute phlegmonous esophagitis and a hypopharyngeal abscess based on computed tomography (CT) findings. However, there was a discrepancy between the clinical course and CT findings. Given the improvement of the patient's condition with conservative treatment with ampicillin/sulbactam, the CT findings suggested an apparent abscess due to increased esophageal wall thickness. However, MR diffusion-weighted images showed a slightly high-intensity signal, suggesting that the enlargement was due to edema rather than an abscess. The patient recovered successfully following conservative treatment. Thus, our findings demonstrate the utility of MRI in the treatment planning of acute phlegmonous esophagitis, especially in cases with unreliable contrast-enhanced CT findings. However, future studies are warranted to explore the utility of MRI in the management of such cases.

Esophageal Stricture after Endoscopic Drainage of Esophageal Abscess as a Complication of Acute Phlegmonous Esophagitis: A Case Report

Esophageal abscess caused by acute phlegmonous esophagitis is rare but life-threatening. Rapid abscess drainage is an important part of the treatment, and endoscope-assisted intra-luminal abscess drainage is frequently performed. Although endoscopic drainage is less invasive than surgery, it has the potential to cause esophageal stricture as a complication. We present a rare case of esophageal stricture as a complication of intra-luminal drainage and evaluate a method to minimize the incidence of esophageal stricture complications.

Phlegmonous esophagitis with mediastinal abscess caused by pharyngeal abscess: a case description.

Phlegmonous esophagitis with mediastinal abscess caused by pharyngeal abscess: a case description.

Acute Phlegmonous Esophagitis as a Complication of Retropharyngeal Abscess

Acute Phlegmonous Esophagitis as a Complication of Retropharyngeal Abscess

Acute Phlegmonous Esophagitis with Mediastinitis Complicated by an Esophageal Perforation: A Case Report

Acute Phlegmonous Esophagitis with Mediastinitis Complicated by an Esophageal Perforation: A Case Report

Phlegmonous esophagitis treated by endoscopic drainage

Phlegmonous esophagitis is a rare and sometimes fatal condition. Cases surgically treated have been reported previously; however, surgical approaches may be risky in the elderly. An 86-year-old woman presented with a sore throat and high fever after eating fish. She was first diagnosed with a deep cervical abscess, and conservative treatment was initially selected. However, her respiratory failure worsened, so emergent tracheostomy and surgical drainage were performed. Computed tomography showed intramural low-density lesions along the entire length of the esophagus and she was diagnosed with phlegmonous esophagitis. To avoid surgical intervention, endoscopic drainage was first attempted. Mucosal incision was made on the lower esophagus guided by endoscopic ultrasonography, using the insulated-tip electrosurgical knife. After the endoscopic drainage, her general health status improved, and the esophageal wall thickness was reduced. While some cases have recovered with conservative treatment, endoscopic drainage may be useful in certain patients.

扁桃周囲膿瘍から波及した食道粘膜下膿瘍の1例

We report the case a 54-year-old male patient who was admitted to our hospital with a sore throat and evidence of a high inflammatory reaction. Computed tomography revealed a peritonsillar abscess extending from the inferior right tonsil to the cervical esophagus, and thickening of the esophageal wall. The pharyngeal abscess was drained through an intraluminal incision in the mesopharynx. Culture of the abscess fluid showed growth of Streptococcus constellatus, one of the organisms of the Streptococcus milleri group. We diagnosed the patient as having phlegmonous esophagitis secondary to peritonsillar abscess. The inflammation was judged to have extended to the submucosal space of the esophagus from the pharyngeal mucosal space. Since the inflammation was contained within the esophageal wall and did not progress to mediastinitis, critical symptoms did not appear and the patient improved through conservative management with antibiotics

Acute phlegmonous esophagitis as a rare but threatening complication of chemoradiotherapy: report of a case

Phlegmonous infection involving the digestive tract has been reported to have a poor prognosis. However, the pathogenesis and clinical features of acute phlegmonous esophagitis have remained unclear due to the rarity of the disease. We herein report a case of acute phlegmonous esophagitis that showed a fulminant course during chemoradiotherapy for uterine cancer. The patient developed septic shock 10 h after postprandial nausea and vomiting, and a computed tomographic scan showed diffuse thickening of the esophageal wall. Severe leukopenia that was refractory to the administration of granulocyte colony-stimulating factor persisted during the first few days. The patient fortunately survived after intensive treatment. The acute phlegmonous esophagitis of the present case might have been evoked and worsened by chemoradiotherapy due to its emetic and myelosuppressive adverse effects, respectively. Although its incidence is extremely rare, acute phlegmonous esophagitis may occur as a life-threatening complication of chemoradiotherapy.

Intramural dissection with mucosal rupture alleviating phlegmonous esophagitis

We report a woman presenting with unrelenting odynophagia and chest pain. Computed tomography identified a deep neck infection with acute phlegmonous esophagitis. However, esophageal intramural dissection with mucosal rupture occurred after routine nasogastric-tube insertion, and pus was vomited thereafter. The patient was treated with antibiotics and delayed endoscopic closure of the rupture site and made a full recovery. Although the definite pathogenesis remained unclear, esophageal intramural dissection with mucosal rupture, a possible and rare complication of nasogastric-tube insertion, eventually alleviated the acute phlegmonous esophagitis in our patient.

Epiphrenic diverticulum associated with suppurative (phlegmonous) esophagitis

Epiphrenic diverticulum associated with suppurative (phlegmonous) esophagitis