A Rare Case of Chicken-Bone-Induced Esophageal Perforation Leading to Cervical Abscess and Esophagocutaneous Fistula

Foreign body (FB) ingestion is a frequent clinical occurrence, but most objects pass spontaneously without complication. Sharp foreign bodies, particularly fish or chicken bones, significantly increase the risk of esophageal perforation, a rare but potentially fatal event. This report describes a 45-year-old woman who presented repeatedly with sore throat, dysphagia, low-grade fevers, weight loss, and a palpable cervical mass after ingesting a chicken bone. Initial evaluations were unrevealing. On gastroenterology referral, her exam revealed left cervical swelling, endoscopy demonstrated purulent drainage from the proximal esophagus, and bedside ultrasound uncovered a complex peri-esophageal fluid collection with air pockets and a suspected retained FB. Aspiration produced purulent fluid concerning an esophagocutaneous fistula. Surgical exploration revealed a deep cervical abscess, and a chicken bone fragment was removed. The esophageal defect was repaired with muscle flap interposition, and a gastrostomy tube was placed for feeding. The patient recovered well, with no postoperative leak on barium swallow. This case highlights the diagnostic challenges of cervical esophageal perforation, particularly when early symptoms are nonspecific and initial imaging is negative. A bedside ultrasound proved valuable in identifying the retained FB and guiding timely intervention. Although delayed diagnosis increases risk, coordinated multidisciplinary management can still achieve excellent outcomes, as shown by this.