DOI: https://doi.org/10.36347/sjmcr.2026.v14i05.022

Pages: 956-959

Esophageal perforation is a rare but life-threatening condition associated with high morbidity and mortality, particularly when complicated by mediastinitis. We report the case of a 43-year-old male presenting with acute respiratory distress and cervical subcutaneous emphysema, in whom contrast-enhanced computed tomography revealed a cervical esophageal perforation with extensive mediastinal collections and right-sided pleural empyema. The patient underwent urgent multidisciplinary management combining broad-spectrum antibiotic therapy, cervico-mediastinal surgical drainage, and enteral nutrition via jejunostomy. Despite a complicated postoperative course marked by loculated pleural effusion, clinical evolution was favorable following appropriate drainage and intensive care support, allowing discharge on day 15. This case underscores the critical importance of early clinical suspicion, prompt imaging, and aggressive multidisciplinary management in improving outcomes in severe esophageal perforation with mediastinal extension.