Hypopharyngeal perforation following minor trauma: a case report and literature review

Smith, Dave; Woolley, Sarah

doi:10.1136/emj.2003.012187

Cited by 25 publications

(27 citation statements)

References 37 publications

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“…The most common cause of pharyngeal perforation is iatrogenic, usually instrumentation (eg, intubation, nasogastric tube placement, or endoscopy) (14). Additional causes include trauma, Figure 6.…”

Section: Nonmalignant Abnormalitiesmentioning

confidence: 99%

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Easier to Swallow: Pictorial Review of Structural Findings of the Pharynx at Barium Pharyngography

Tao

Menias

Herman³

et al. 2013

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Barium pharyngography remains an important diagnostic tool in the evaluation of patients with dysphagia. Pharyngography can not only help detect functional abnormalities but also help identify a wide spectrum of structural abnormalities in children and adults. These structural abnormalities may reflect malignant or nonmalignant oropharyngeal, hypopharyngeal, or laryngeal processes that deform or alter normal coated mucosal surfaces. Therefore, an understanding of the normal appearance of the pharynx at contrast material-enhanced imaging is necessary for accurate detection and interpretation of abnormal findings. Congenital malformations are more typically identified in the younger population; inflammatory and infiltrative diseases, trauma, foreign bodies, and laryngeal cysts can be seen in all age groups; and Zenker and Killian-Jamieson diverticula tend to occur in the older population. Squamous cell carcinoma is by far the most common malignant process, with contrast-enhanced imaging findings that depend on tumor location and morphology. Treatments of head and neck cancers include total laryngectomy and radiation therapy, both of which alter normal anatomy. Patients are usually evaluated immediately after laryngectomy to detect complications such as fistulas; later, pharyngography is useful for identifying and characterizing strictures. Deviation from the expected posttreatment appearance, such as irregular narrowing or mucosal nodularity, should prompt direct visualization to evaluate for recurrence. Contrast-enhanced imaging of the pharynx is commonly used in patients who present with dysphagia, and radiologists should be familiar with the barium pharyngographic appearance of the normal pharyngeal anatomy and of some of the processes that alter normal anatomy.

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Section: Nonmalignant Abnormalitiesmentioning

confidence: 99%

“…Contrast-enhanced imaging demonstrates leakage of contrast material from the perforation site. The majority of cases can be managed conservatively (14).…”

Section: Figurementioning

confidence: 99%

Easier to Swallow: Pictorial Review of Structural Findings of the Pharynx at Barium Pharyngography

Tao

Menias

Herman³

et al. 2013

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“…6,7 When suspected, x-ray of the neck in a lateral projection will demonstrate retropharyngeal air when present and a Gastrografin ® swallow or computed tomography with oral contrast will clarify the anatomical site of the leak. 8,9 Additionally, endoscopic examination may reveal the tear, its site and size as well as the presence of oedema or haematoma in the region. 10 However, it may fail to show the abnormality 11 if vigilance is not exercised, as in our case.…”

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confidence: 99%

“…The conservative approach includes keeping the patient on nil by mouth and institution of nasogastric feeding with the administration of intravenous antibiotics. 9,[17][18][19] On the other hand, if chosen, surgical repair may be carried out through the transoral 14 or transcervical routes and is always accompanied by drainage. 8,20 Pharyngocutaneous fistula is a known complication of total laryngectomy, performed for laryngeal or hypopharyngeal carcinoma.…”

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confidence: 99%

Hypopharyngeal fistula complicating difficult thyroidectomy for invasive papillary cancer

Rabie

2014

annals

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Thyroidectomy is associated with certain known complications, including recurrent laryngeal or superior laryngeal nerve injury and hypocalcaemia due to hypoparathyroidism. Other much rarer complications include oesophageal injury with oesophageal fistula formation. In this report, we describe the clinical course of a patient with an invasive papillary thyroid carcinoma who underwent total thyroidectomy and developed hypopharyngeal fistula in the immediate postoperative period, a complication that has never been reported previously following thyroidectomy. Under conservative treatment, the fistula closed within two weeks and the patient was referred, in good condition, to the oncologist for completion of therapy.

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“…Treatment varies and may range from immediate surgical repair to conservative management and observation [3]. In addition to establishing an airway, antibiotics are often administered in non-operative cases to prevent abscess formation and mediastinitis; although controversy exists in this use of prophylactic antibiotics owing to how infrequently pharyngeal perforation is encountered [4].…”

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confidence: 99%

A man with drug-induced psychosis attempts to swallow his cellular phone

et al. 2013

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A 35 year-old man with no significant past medical history presented to the emergency department (ED) after abusing phencyclidine (PCP). Responding to command auditory hallucinations, he attempted to swallow his 4 cm 9 8 cm smartphone. On arrival, he was agitated but alert, handling his secretions poorly and in moderate respiratory distress. An electronic device was clearly protruding from his oropharynx. He was tachypneic (24 respirations/min) with an oxygen saturation of 92 % on room air, a heart rate of 131 beats per minute and a blood pressure of 137/64 mmHg.Emergency physicians immediately attempted to remove the device with Magill forceps, but were unsuccessful. A ''trauma code'' was announced bringing a surgical intensivist, an anesthesiologist, and appropriate nursing staff to the bedside, while simultaneously indicating that an operating room (OR) should be prepared. The patient was emergently transported to the OR and ''double prepped'' for both emergent cricothyrotomy and oropharyngeal intubation. The device was successfully removed under procedural sedation without the need for surgical intervention. A mucosal tear was noted in the posterior pharynx. The patient became markedly agitated post-procedure, and, given the recent trauma, was intubated for airway protection. He subsequently developed bilateral pneumothoraces and significant subcutaneous emphysema throughout his neck and upper torso.Diagnosis: Posterior pharyngeal rupture and bilateral pneumothoraces following attempted foreign body ingestion (Fig. 1). Computerized tomography of the neck and chest revealed a defect in the posterior wall of the oropharynx at the C2 level, along with significant mediastinal air and right-greater-than-left pneumothoraces. The patient was treated with a right-sided chest tube and was observed in the intensive care unit. He was treated for 7 days with broad-spectrum antibiotics, specifically, piperacillin and tazobactam. He did not require surgical repair of the pharyngeal defect and was discharged from the hospital 2 weeks later.

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Hypopharyngeal perforation following minor trauma: a case report and literature review

Cited by 25 publications

References 37 publications

Easier to Swallow: Pictorial Review of Structural Findings of the Pharynx at Barium Pharyngography

Easier to Swallow: Pictorial Review of Structural Findings of the Pharynx at Barium Pharyngography

Hypopharyngeal fistula complicating difficult thyroidectomy for invasive papillary cancer

A man with drug-induced psychosis attempts to swallow his cellular phone

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