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Open Access 01-12-2022 | Mediastinitis | Research

Factors affecting perforation of the esophagus in patients with deep neck infection

Authors: Shih-Lung Chen, Chia-Ying Ho, Shy-Chyi Chin, Yu-Chien Wang

Published in: BMC Infectious Diseases | Issue 1/2022

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Abstract

Background

Deep neck infection (DNI) is a serious disease that can lead to severe morbidity, including esophageal perforation, and mortality. However, no previous study has explored the risk factors associated with esophageal perforation in patients with DNI. This study investigated these factors.

Methods

Between September 2015 and September 2021, 521 patients with DNI were studied. Relevant clinical variables and deep neck spaces were assessed.

Results

In a multivariate analysis, involvement of the retropharyngeal space (OR 5.449, 95% CI 1.603–18.51, p = 0.006) and the presence of mediastinitis (OR 218.8, 95% CI 55.98–855.3, p < 0.001) were independent risk factors associated with esophageal perforation in patients with DNI.
There were no differences in pathogens between 32 patients with and 489 patients without esophageal perforation (all p > 0.05).

Conclusion

Involvement of the retropharyngeal space and the presence of mediastinitis were independent risk factors associated with esophageal perforation in patients with DNI. There were no differences in pathogens between the groups with and without esophageal perforation in DNI.
Literature
1.
go back to reference Velhonoja J, Laaveri M, Soukka T, Irjala H, Kinnunen I. Deep neck space infections: an upward trend and changing characteristics. Eur Arch Otorhinolaryngol. 2020;277(3):863–72.CrossRef Velhonoja J, Laaveri M, Soukka T, Irjala H, Kinnunen I. Deep neck space infections: an upward trend and changing characteristics. Eur Arch Otorhinolaryngol. 2020;277(3):863–72.CrossRef
2.
go back to reference Tapiovaara L, Back L, Aro K. Comparison of intubation and tracheotomy in patients with deep neck infection. Eur Arch Otorhinolaryngol. 2017;274(10):3767–72.CrossRef Tapiovaara L, Back L, Aro K. Comparison of intubation and tracheotomy in patients with deep neck infection. Eur Arch Otorhinolaryngol. 2017;274(10):3767–72.CrossRef
3.
go back to reference Rzepakowska A, Rytel A, Krawczyk P, Osuch-Wojcikiewicz E, Widlak I, Deja M, Niemczyk K. The factors contributing to efficiency in surgical management of purulent infections of deep neck spaces. Ear Nose Throat J. 2021;100(5):354–9.CrossRef Rzepakowska A, Rytel A, Krawczyk P, Osuch-Wojcikiewicz E, Widlak I, Deja M, Niemczyk K. The factors contributing to efficiency in surgical management of purulent infections of deep neck spaces. Ear Nose Throat J. 2021;100(5):354–9.CrossRef
4.
go back to reference Boscolo-Rizzo P, Marchiori C, Montolli F, Vaglia A, Da Mosto MC. Deep neck infections: a constant challenge. ORL J Otorhinolaryngol Relat Spec. 2006;68(5):259–65.CrossRef Boscolo-Rizzo P, Marchiori C, Montolli F, Vaglia A, Da Mosto MC. Deep neck infections: a constant challenge. ORL J Otorhinolaryngol Relat Spec. 2006;68(5):259–65.CrossRef
5.
go back to reference Prado-Calleros HM, Jimenez-Fuentes E, Jimenez-Escobar I. Descending necrotizing mediastinitis: systematic review on its treatment in the last 6 years, 75 years after its description. Head Neck. 2016;38(Suppl 1):E2275-2283.CrossRef Prado-Calleros HM, Jimenez-Fuentes E, Jimenez-Escobar I. Descending necrotizing mediastinitis: systematic review on its treatment in the last 6 years, 75 years after its description. Head Neck. 2016;38(Suppl 1):E2275-2283.CrossRef
6.
go back to reference Aizawa N, Tsuchiya A, Takahashi S. Two cases of deep neck infection with esophageal perforation. J-STAGE. 2013;26(2):149–54. Aizawa N, Tsuchiya A, Takahashi S. Two cases of deep neck infection with esophageal perforation. J-STAGE. 2013;26(2):149–54.
7.
go back to reference Ho CY, Chin SC, Wang YC, Chen SL. Factors affecting patients with concurrent deep neck infection and aspiration pneumonia. Am J Otolaryngol. 2022;43(3): 103463.CrossRef Ho CY, Chin SC, Wang YC, Chen SL. Factors affecting patients with concurrent deep neck infection and aspiration pneumonia. Am J Otolaryngol. 2022;43(3): 103463.CrossRef
8.
go back to reference Chen SL, Chin SC, Wang YC, Ho CY. factors affecting patients with concurrent deep neck infection and Lemierre’s syndrome. Diagnostics (Basel). 2022;12(4):1–8. Chen SL, Chin SC, Wang YC, Ho CY. factors affecting patients with concurrent deep neck infection and Lemierre’s syndrome. Diagnostics (Basel). 2022;12(4):1–8.
9.
go back to reference Chen SL, Young CK, Tsai TY, Chien HT, Kang CJ, Liao CT, Huang SF. Factors affecting the necessity of tracheostomy in patients with deep neck infection. Diagnostics (Basel). 2021;11(9):1536.CrossRef Chen SL, Young CK, Tsai TY, Chien HT, Kang CJ, Liao CT, Huang SF. Factors affecting the necessity of tracheostomy in patients with deep neck infection. Diagnostics (Basel). 2021;11(9):1536.CrossRef
10.
go back to reference Wang LF, Tai CF, Kuo WR, Chien CY. Predisposing factors of complicated deep neck infections: 12-year experience at a single institution. J Otolaryngol Head Neck Surg. 2010;39(4):335–41.PubMed Wang LF, Tai CF, Kuo WR, Chien CY. Predisposing factors of complicated deep neck infections: 12-year experience at a single institution. J Otolaryngol Head Neck Surg. 2010;39(4):335–41.PubMed
11.
go back to reference Soreide JA, Viste A. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med. 2011;19:66.CrossRef Soreide JA, Viste A. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med. 2011;19:66.CrossRef
12.
go back to reference Lam HC, Woo JK, van Hasselt CA. Esophageal perforation and neck abscess from ingested foreign bodies: treatment and outcomes. Ear Nose Throat J. 2003;82(10):786.CrossRef Lam HC, Woo JK, van Hasselt CA. Esophageal perforation and neck abscess from ingested foreign bodies: treatment and outcomes. Ear Nose Throat J. 2003;82(10):786.CrossRef
13.
go back to reference Li WX, Dong Y, Zhang A, Tian J, Lu C, Quraishi MS, Liu L. Management of deep neck infections from cervical esophageal perforation caused by foreign body: a case series study. Am J Otolaryngol. 2021;42(2): 102870.CrossRef Li WX, Dong Y, Zhang A, Tian J, Lu C, Quraishi MS, Liu L. Management of deep neck infections from cervical esophageal perforation caused by foreign body: a case series study. Am J Otolaryngol. 2021;42(2): 102870.CrossRef
14.
go back to reference Wang LT, Lee SC, Tzao C, Chang H, Cheng YL. Successful treatment for a delay-diagnosed esophageal perforation with deep neck infection, mediastinitis, empyema, and sepsis. South Med J. 2007;100(7):727–8.CrossRef Wang LT, Lee SC, Tzao C, Chang H, Cheng YL. Successful treatment for a delay-diagnosed esophageal perforation with deep neck infection, mediastinitis, empyema, and sepsis. South Med J. 2007;100(7):727–8.CrossRef
15.
go back to reference Yang SW, Lee MH, See LC, Huang SH, Chen TM, Chen TA. Deep neck abscess: an analysis of microbial etiology and the effectiveness of antibiotics. Infect Drug Resist. 2008;1:1–8.CrossRef Yang SW, Lee MH, See LC, Huang SH, Chen TM, Chen TA. Deep neck abscess: an analysis of microbial etiology and the effectiveness of antibiotics. Infect Drug Resist. 2008;1:1–8.CrossRef
16.
go back to reference Chen MK, Wen YS, Chang CC, Lee HS, Huang MT, Hsiao HC. Deep neck infections in diabetic patients. Am J Otolaryngol. 2000;21(3):169–73.CrossRef Chen MK, Wen YS, Chang CC, Lee HS, Huang MT, Hsiao HC. Deep neck infections in diabetic patients. Am J Otolaryngol. 2000;21(3):169–73.CrossRef
17.
go back to reference Neyaz Z, Gupta M, Ghoshal UC. How to perform and interpret timed barium esophagogram. J Neurogastroenterol Motil. 2013;19(2):251–6.CrossRef Neyaz Z, Gupta M, Ghoshal UC. How to perform and interpret timed barium esophagogram. J Neurogastroenterol Motil. 2013;19(2):251–6.CrossRef
18.
go back to reference Romero RV, Goh K-L. Esophageal perforation: Continuing challenge to treatment. Gastrointest Interv. 2013;2(1):1–6.CrossRef Romero RV, Goh K-L. Esophageal perforation: Continuing challenge to treatment. Gastrointest Interv. 2013;2(1):1–6.CrossRef
19.
go back to reference Kaman L, Iqbal J, Kundil B, Kochhar R. Management of esophageal perforation in adults. Gastroenterol Res. 2010;3(6):235–44. Kaman L, Iqbal J, Kundil B, Kochhar R. Management of esophageal perforation in adults. Gastroenterol Res. 2010;3(6):235–44.
20.
go back to reference Gujrathi AB, Ambulgekar V, Kathait P. Deep neck space infection—a retrospective study of 270 cases at tertiary care center. World J Otorhinolaryngol Head Neck Surg. 2016;2(4):208–13.CrossRef Gujrathi AB, Ambulgekar V, Kathait P. Deep neck space infection—a retrospective study of 270 cases at tertiary care center. World J Otorhinolaryngol Head Neck Surg. 2016;2(4):208–13.CrossRef
21.
go back to reference Kinzer S, Pfeiffer J, Becker S, Ridder GJ. Severe deep neck space infections and mediastinitis of odontogenic origin: clinical relevance and implications for diagnosis and treatment. Acta Otolaryngol. 2009;129(1):62–70.CrossRef Kinzer S, Pfeiffer J, Becker S, Ridder GJ. Severe deep neck space infections and mediastinitis of odontogenic origin: clinical relevance and implications for diagnosis and treatment. Acta Otolaryngol. 2009;129(1):62–70.CrossRef
22.
go back to reference Ho CY, Wang YC, Chin SC, Chen SL. Factors creating a need for repeated drainage of deep neck infections. Diagnostics (Basel). 2022;12(4):940.CrossRef Ho CY, Wang YC, Chin SC, Chen SL. Factors creating a need for repeated drainage of deep neck infections. Diagnostics (Basel). 2022;12(4):940.CrossRef
23.
go back to reference Huang TT, Liu TC, Chen PR, Tseng FY, Yeh TH, Chen YS. Deep neck infection: analysis of 185 cases. Head Neck. 2004;26(10):854–60.CrossRef Huang TT, Liu TC, Chen PR, Tseng FY, Yeh TH, Chen YS. Deep neck infection: analysis of 185 cases. Head Neck. 2004;26(10):854–60.CrossRef
24.
go back to reference Wang LF, Kuo WR, Tsai SM, Huang KJ. Characterizations of life-threatening deep cervical space infections: a review of one hundred ninety-six cases. Am J Otolaryngol. 2003;24(2):111–7.CrossRef Wang LF, Kuo WR, Tsai SM, Huang KJ. Characterizations of life-threatening deep cervical space infections: a review of one hundred ninety-six cases. Am J Otolaryngol. 2003;24(2):111–7.CrossRef
25.
go back to reference Vieira F, Allen SM, Stocks RM, Thompson JW. Deep neck infection. Otolaryngol Clin N Am. 2008;41(3):459–83.CrossRef Vieira F, Allen SM, Stocks RM, Thompson JW. Deep neck infection. Otolaryngol Clin N Am. 2008;41(3):459–83.CrossRef
26.
go back to reference Chong VF, Fan YF. Radiology of the retropharyngeal space. Clin Radiol. 2000;55(10):740–8.CrossRef Chong VF, Fan YF. Radiology of the retropharyngeal space. Clin Radiol. 2000;55(10):740–8.CrossRef
27.
go back to reference Chen TC, Wu MH, Cheng YJ, Chang PC. Spontaneous pharyngoesophageal perforations. Eur J Cardiothorac Surg. 2011;40(5):1250–2.PubMed Chen TC, Wu MH, Cheng YJ, Chang PC. Spontaneous pharyngoesophageal perforations. Eur J Cardiothorac Surg. 2011;40(5):1250–2.PubMed
28.
go back to reference Lin CY, Peng CC, Chiu NC, Wang NL, Lee KS. Esophageal perforation, mediastinitis, and retropharyngeal abscess after eel intrusion. Pediatr Infect Dis J. 2009;28(5):451–2.CrossRef Lin CY, Peng CC, Chiu NC, Wang NL, Lee KS. Esophageal perforation, mediastinitis, and retropharyngeal abscess after eel intrusion. Pediatr Infect Dis J. 2009;28(5):451–2.CrossRef
29.
go back to reference Estrera AS, Landay MJ, Grisham JM, Sinn DP, Platt MR. Descending necrotizing mediastinitis. Surg Gynecol Obstet. 1983;157(6):545–52.PubMed Estrera AS, Landay MJ, Grisham JM, Sinn DP, Platt MR. Descending necrotizing mediastinitis. Surg Gynecol Obstet. 1983;157(6):545–52.PubMed
30.
go back to reference Levine MS, Rubesin SE. Diseases of the esophagus: diagnosis with esophagography. Radiology. 2005;237(2):414–27.CrossRef Levine MS, Rubesin SE. Diseases of the esophagus: diagnosis with esophagography. Radiology. 2005;237(2):414–27.CrossRef
31.
go back to reference Pulst-Korenberg A, Morris SC. Descending necrotizing mediastinitis resulting from pharyngitis with perforation of the aryepiglottic fold. Case Rep Emerg Med. 2020;2020:4963493.PubMedPubMedCentral Pulst-Korenberg A, Morris SC. Descending necrotizing mediastinitis resulting from pharyngitis with perforation of the aryepiglottic fold. Case Rep Emerg Med. 2020;2020:4963493.PubMedPubMedCentral
32.
go back to reference Minnich DJ, Patrick Yu, Bryant AS, Jarrar D. Management of thoracic esophageal perforations. Eur J Cardiothorac Surg. 2011;40:931–8.PubMed Minnich DJ, Patrick Yu, Bryant AS, Jarrar D. Management of thoracic esophageal perforations. Eur J Cardiothorac Surg. 2011;40:931–8.PubMed
33.
go back to reference Reeder LB, DeFilippi VJ, Ferguson MK. Current results of therapy for esophageal perforation. Am J Surg. 1995;169(6):615–7.CrossRef Reeder LB, DeFilippi VJ, Ferguson MK. Current results of therapy for esophageal perforation. Am J Surg. 1995;169(6):615–7.CrossRef
34.
go back to reference Han JK, Kerschner JE. Streptococcus milleri: an organism for head and neck infections and abscess. Arch Otolaryngol Head Neck Surg. 2001;127(6):650–4.CrossRef Han JK, Kerschner JE. Streptococcus milleri: an organism for head and neck infections and abscess. Arch Otolaryngol Head Neck Surg. 2001;127(6):650–4.CrossRef
35.
go back to reference Gossling J. Occurrence and pathogenicity of the Streptococcus milleri group. Rev Infect Dis. 1988;10(2):257–85.CrossRef Gossling J. Occurrence and pathogenicity of the Streptococcus milleri group. Rev Infect Dis. 1988;10(2):257–85.CrossRef
36.
go back to reference Whiley RA, Beighton D. Emended descriptions and recognition of Streptococcus constellatus, Streptococcus intermedius, and Streptococcus anginosus as distinct species. Int J Syst Bacteriol. 1991;41(1):1–5.CrossRef Whiley RA, Beighton D. Emended descriptions and recognition of Streptococcus constellatus, Streptococcus intermedius, and Streptococcus anginosus as distinct species. Int J Syst Bacteriol. 1991;41(1):1–5.CrossRef
Metadata
Title
Factors affecting perforation of the esophagus in patients with deep neck infection
Authors
Shih-Lung Chen
Chia-Ying Ho
Shy-Chyi Chin
Yu-Chien Wang
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2022
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-022-07480-6

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