Thoracoscopic-guided paraesophageal abscess drainage in foreign body-induced esophageal perforation: a case report

Esophageal perforation is a life-threatening emergency, especially when diagnosis is delayed or when the thoracic esophagus is involved. Controlling mediastinal contamination is critical, yet the optimal drainage strategy for contained mediastinal abscesses remains controversial. We report the case of a 76-year-old woman with a foreign body-induced lower thoracic esophageal perforation complicated by a contained paraesophageal abscess. After endoscopic removal of an impacted blister pack, primary repair was not feasible due to severe inflammation and friable tissue. Video-assisted thoracoscopic exploration revealed an intact mediastinal pleura with a localized abscess. Thoracoscopically guided percutaneous drainage using a 14-Fr pigtail catheter was performed to achieve source control while avoiding uncontrolled pleural contamination. The patient recovered uneventfully, with complete healing of the esophageal perforation. This case demonstrates that thoracoscopically guided percutaneous drainage can be a safe, organ-preserving option for carefully selected patients with contained mediastinal abscesses.