Unusual Cause of Parapharyngeal Abscess


Authors: T. Rybnikár;  P. Čelakovský;  J. Vokurka
Authors‘ workplace: Klinika ušní, nosní, krční LF UK a FN, Hradec Králové přednosta doc. MUDr. J. Vokurka, CSc.
Published in: Otorinolaryngol Foniatr, 58, 2009, No. 4, pp. 242-245.
Category: Case History

Overview

A perforation in the area of hypopharynx and esophagus of iatrogenic origin belong to rare but very serious conditions. Among esophagus perforations the iatrogenic injury is the most frequent cause reaching up to 88.4% (1). The individual interventions include the injury during orotracheal intubations and endoscopic examination of the swallowing pathways. The risk of iatrogenic perforations of esophagus has been found in up to 1.2% of rigid esophagoscopy examinations and 0.05% in the flexible ones (2, 3, 4). Lethality is in the range of 0.5 to 3 per 10,000 of cases (5). The prognosis of iatrogenic perforations is better than in the spontaneous or traumatic perforations, where mortality reported in literature is in the range of 9 to 32% (6, 7, 8).

The present case report describes a rare case of hypopharynx perforation caused by introduction of stomach probe for stomach irrigation. It also shows some moments which resulted in a late recognition of instrumental injury. The delayed diagnostics resulted in the development of deep cervical inflammation with alteration of general condition and beginning mediastinitis. The authors describe a diagnostic algorithm and surgical treatment after the developed parapharyngeal and retropharyngeal abscess and discuss etiology of perforation injuries of the swallowing passages.

Key words:
parapharyngeal abscess, perforation of hypopharynx, iatrogenic injury.


Sources

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3. Lam, H. CH., Woo, J. K., Van Hasselt, CH.: Esophageal perforation and neck abscess from ingested foreign bodies. Ear, Nose Throat, 82, 2003, s. 786, s. 789-794.

4. Lánský, M., Růžička, J., Sršatá, J.,Čelakovský, P. : Perforace jícnu při flexibilní gastroskopii. Čes. Otolaryngol., 2004, 2, s. 92-95.

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7. Shafqat, H., Al, N., Jilaihawi, A., Dhruva, P.: Conservative management of iatrogenic oesophageal perforations. Eur. J. Cardiothorac. Surgery, 28, 2005, s. 7-10.

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9. Vogel, S. B., Rout, R., Martin, T. D., Abbitt, L.: Esophageal perforation in adults. Ann. Surg., 241, 2005, s. 1016-1023.

10. Wolff, A. P., Kun, F. A., Obuta, J. H.: Pharyngeal – oesophageal perforations associated with rapid oral endotracheal intubation. Ann. Otol., Rhinol. Laryngol., 81, 1972, s. 258-261.

Labels
Audiology Paediatric ENT ENT (Otorhinolaryngology)
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