Intramural Esophageal Abscess Managed by Open Cervical Drainage

Intramural esophageal abscess is an exceptionally rare condition that often mimics submucosal tumors or inflammatory disorders, resulting in diagnostic delay and potential life-threatening complications. We describe the case of an 83-year-old woman who presented with persistent neck pain and odynophagia. Imaging demonstrated an intramural abscess extending from the pre-epiglottic space into the mediastinum. Although endoscopic drainage was initially considered, it was not performed because of the high risk of perforation. The patient underwent open cervical drainage, and Streptococcus anginosus was isolated from the pus culture. She subsequently recovered fully after surgical intervention and appropriate postoperative antibiotic therapy. While minimally invasive endoscopic approaches have been increasingly reported in the management of intramural esophageal abscess, this case emphasizes that open surgical drainage remains an essential therapeutic option when endoscopic access is not feasible or when disease involvement is extensive, underscoring the need for early recognition and tailored treatment strategies.