A case of phlegmonous esophagitis complicated by pharyngeal infection: so-called descending necrotizing esophagitis

Descending necrotizing mediastinitis (DNM) is a fatal disease caused by odontogenic or pharyngeal infection extending into the mediastinum along the deep fascial surface, retropharyngeal space, or peritracheal space. Although the esophagus is generally excluded from the infectious spillover route, in extremely rare cases deep neck infections can cause phlegmonous esophagitis. Herein, we report a case of phlegmonous esophagitis that was difficult to differentiate from DNM. A 61-year-old man was diagnosed with deep neck infection and DNM based on radiological findings and underwent emergency cervical drainage with a tracheostomy and right thoracotomy with mediastinal drainage. Intraoperative findings showed swelling of the entire esophagus, and esophageal esophagitis was diagnosed by esophagogastroduodenoscopy following surgery. The patient made favorable progress on treatment with antibiotics and fasting. To accurately diagnose this severe condition (so-called descending necrotizing esophagitis) radiologic and intraoperative intrapleural findings are important.