Abstract
BACKGROUND: Idiopathic esophageal perforation complicated by thyroid abscess formation constitutes a rare and severe clinical emergency. The precise pathogenesis of this condition remains elusive, and its potential for recurrence necessitates further investigation to establish evidence-based, personalized therapeutic protocols. CASE DESCRIPTION: We present a case of a 41-year-old female who initially presented with a spontaneous cervical esophageal perforation associated with an ipsilateral thyroid abscess. The patient underwent prompt surgical intervention consisting of meticulous debridement and drainage, facilitated by intraoperative neuromonitoring to preserve recurrent laryngeal nerve function and thyroid integrity. The postoperative course was uneventful, and the patient was discharged with preserved thyroid function. However, a recurrence manifested 10 months postoperatively. In light of the well-localized abscess and the patient's hemodynamically stable condition, a conservative management strategy was instituted. This approach, comprising targeted antimicrobial therapy and vigilant clinical surveillance, resulted in complete resolution without the need for further surgical intervention. CONCLUSIONS: This case provides substantive clinical insights for formulating individualized management strategies for idiopathic esophageal perforation. A review of the extant literature suggests that underlying anatomical anomalies, such as congenital weakness or diverticula, may predispose individuals to recurrent episodes. This underscores the imperative of tailoring treatment-ranging from aggressive surgical intervention to meticulous conservative management-based on a comprehensive assessment of infection severity, anatomical involvement, and the patient's overall clinical status. Further multicentric studies are warranted to elucidate the etiopathogenesis and to refine risk-stratified treatment algorithms for this uncommon but potentially life-threatening condition.