EVT-Inspired Simplified Negative-Pressure Nasoesophageal Drainage for Cervical Abscess Secondary to Esophageal...

BACKGROUND Esophageal foreign body perforation is a critical emergency needing prompt diagnosis and intervention. The innovative esophageal vacuum therapy (EVT) has been proven effective in the treatment of esophageal perforations and fistulas. However, its high cost and technical complexity limit its widespread use in primary care facilities. CASE REPORT A 52-year-old man presented after 4 days of odynophagia and 1 day of fever following accidental fish bone ingestion. Computed tomography (CT) demonstrated cervical esophageal perforation with soft-tissue emphysema. Endoscopy revealed a 5-mm penetrating ulcer on the left esophageal wall, 20 cm from the incisors, with purulent discharge. The patient initially declined nasogastric decompression and was treated conservatively with nil per os, intravenous antibiotics, proton pump inhibitors, and parenteral nutrition. After 48 hours, clinical deterioration occurred with worsening pain. The patient then consented to EVT-inspired simplified negative-pressure nasoesophageal drainage: a 16-Fr nasogastric tube with 3 side holes was blindly inserted to the mid-esophagus and connected to a disposable negative pressure drainage ball. A second CT performed the same day confirmed abscess expansion (43×20×48 mm) and tube positioning. Daily drainage decreased and symptoms improved. Eight days later, CT confirmed abscess resolution. Endoscopy revealed perforation epithelialization, and a residual ulcer was closed with 1 clip. The patient resumed oral intake and was discharged on day 18. CONCLUSIONS In this case, EVT-inspired simplified negative-pressure nasoesophageal drainage demonstrated effectiveness in controlling local infection and avoiding surgery for cervical esophageal perforation with a contained abscess. This easily reproducible technique may serve as a temporary bridging therapy when standard EVT or surgery is unavailable.