Abstract
Objective: To report an unusual case of pyriform sinus-pleural-mediastinal fistula secondary to internal penetrating trauma by a toothbrush, with emphasis on management options. Case report: A 26-year-old woman swallowed a toothbrush in a violent manner 8 months ago in an attempt of self-mutilation. She immediately complained of neck pain and dysphagia. She was diagnosed with pyriform sinus-pleural-mediastinal fistula. The fistula was repaired. Primary closure was performed and covered with the sternocleidomastoid muscle flap, and reinforced with thyroid tissue and surrounding tissues. The patient did not present any complications or recurrence, and she gained weight after the operation. Conclusion: Early recognition of hypopharyngeal perforation is important, and in selected cases, immediate repair of the perforation can lead to a good prognosis.
Highlights
Perforation of the hypopharynx is a rare injury, accounting for less than 2% of all perforations in the pharynxgoesophageal region [1]
We present a clinical case of pyriform sinus-pleural-mediastinal fistula, which to our knowledge, has not been previously described
We found a fistula opening at the bottom of the right pyriform sinus, below the level of the arytenoid cartilage and close to the esophageal entrance (Figure 2), which was diagnosed as hypopharynx fistulization
Summary
Perforation of the hypopharynx is a rare injury, accounting for less than 2% of all perforations in the pharynxgoesophageal region [1]. The most common cause of hyperpharyngeal perforation is iatrogenic. The current treatment of hypopharyngeal perforation includes conservative treatment and surgical intervention. Pyriform sinus perforations with a chronic disease process are even rarer. A toothbrush has not been reported as the cause of an in-. (2014) Chronic Pyriform Sinus-Pleural-Mediastinal Fistula Secondary to an Internal Penetrating Trauma by a Toothbrush. We present a clinical case of pyriform sinus-pleural-mediastinal fistula, which to our knowledge, has not been previously described. Diagnostic imaging evaluation, and operative management of the patient are described, as well as a review of the literature
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