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DOI: 10.1055/a-2325-2770
Comprehensive endoscopic management of recurrent esophageal wall abscess revealing concomitant eosinophilic esophagitis
Authors
Esophageal wall abscesses (EWAs) are rare lesions often linked to post-traumatic or inflammatory causes. To date, no authors have described their association with a diagnosis of eosinophilic esophagitis (EoE). While typically managed surgically owing to expertise constraints, this approach carries invasive risks, including mediastinitis. Interventional endoscopy offers a less invasive alternative, aiding both comprehensive treatment and etiologic diagnostic evaluation. Here, we report a case of recurrent EWA post-surgical debridement, treated endoscopically via wall incision, purulent content aspiration, and complete abscess fenestration into the esophageal cavity. Surprisingly, endoscopy revealed concomitant EoE.
A 24-year-old man presented with septic shock from a recurrent EWA, 11 cm in length, which had undergone previous surgical management. Endoscopic intervention was pursued this time.
Endoscopic ultrasound revealed a confined submucosal collection. Mucosal bulging and a small orifice, possibly from prior trauma or fistulization, were noted ([Video 1]). A 3-cm esophageal wall incision allowed access to the abscessed cavity for drainage and irrigation ([Fig. 1]), followed by closure with clips and insertion of a plastic stent for guided healing.
Endoscopic management of recurrent esophageal wall abscess revealing concomitant eosinophilic esophagitis.Video 1
Epithelialization of the treated cavity was observed 3 weeks later. It was separated from the esophageal lumen by a 10-cm long mucosal and fibrous septum ([Fig. 2]), which was fully sectioned without incident. Endoscopic follow-up at 4 months revealed satisfactory healing, albeit with typical signs of EoE ([Fig. 3]), with an EREFS (edema, rings, exudate, furrows, stricture) [1] score of 5.
This case demonstrates that EWAs can be effectively and comprehensively treated in a minimally invasive manner through endoscopy.
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Conflict of Interest
The authors declare that they have no conflict of interest.
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Reference
- 1 Hirano I, Moy N, Heckman MG. et al. Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system. Gut 2013; 62: 489-495
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Publication History
Article published online:
12 June 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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Reference
- 1 Hirano I, Moy N, Heckman MG. et al. Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system. Gut 2013; 62: 489-495