Abstract: Objective:To explore the clinical manifestations and treatments of retro-esophageal space abscess.Method:The clinical data of 27 cases with retro-esophageal space abscess were analyzed retrospectively. Twenty-one cases (77.78%) were secondary to acute injury of esophageal meatus caused by foreign bodies. 2 cases (7.41%)were secondary to old foreign body infection in retro-esophageal space, 3 cases (11.11%) after secondary to pharyngeal abscess, and 1 case (3.70%) was unknown to etiology. All patients were confirmed by sectional medicalimageology. Six cases(Conservation group, C group) were treated conservatively and 6 cases (Oropharyngeal incision group, OI group) were performed with oropharyngeal incision drainage. 15 cases(Extra-neck incision group, ENI group)were performed with extra-neck incision and vacuum sealing drainage.Result:In C group, 6 cases were cured with conservative therapy and the average hospital stay was 15.6 days. In OI group, 5 cases were healed with oropharyngeal drainage but aspiration pneumonia complicated with septic shock occurred in 2 cases, and 1 case dead from septic shock secondary to mediastinum and lung abscess. The average hospital stay was 18.8 days. In ENI group, 15 patients were cured with extra-neck drainage without complication and the average hospital stay was 9.5 days.Conclusion:The main causes of retro-esophageal space abscess are foreign body injury of upper esophagus and remnant of retro-esophageal space. Sectional medicalimageology can be of important value of diagnosis and treatment for displaying the retro-esophageal space abscess and other deep cervical fascia space sufficiently. Incision and vacuum sealing drainage via extra-neck is an effective therapy while oropharyngeal drainage is less effective and is not advocated as a primary treatment because of aspiration pneumonia complication. Conservative cure is a choice for patients without dyspnoea and background diseases, and it is necessary to recognize and treat severe complications early.