Retropharyngeal emphysema: An unusual aetiology—A case report and literature review

Abstract

Introduction: Retropharyngeal emphysema is a potentially life threatening condition which may require urgent diagnosis and intervention. It has been documented to occur following trauma to the aerodigestive tract and is usually accompanied by subcutaneous emphysema of the cervical region. This condition may be complicated by mediastinal emphysema and pneumomediastinum. Foreign body ingestion is quite common in little children and in this environment; a cultural practice is for mothers or other caregivers to attempt to remove these foreign bodies by forcing their finger(s) down the oropharynx and Hypopharynx of these young children. This usually results in injuries to these anatomical sites. Retropharyngeal emphysema complicating this practice is rarely reported. Case presentation: We present the case of a 4-year-old Nigerian boy who presented with stridor and severe dyspnoea following repeated attempts at removal of a purportedly ingested foreign body by his mother. Examination revealed oedema of the soft palate with small multiple bleeding shallow lacerations of the oropharyngeal walls. Oxygen therapy was commenced and preparations for urgent upper airway intervention made. Soft tissue neck X-ray revealed retropharyngeal and subcutaneous emphysema with upper airway compromise. Conservative treatment with high dose steroids and antibiotics led to a gradual resolution of the condition. Conclusion: This is a rarely reported complication of this relatively common socio-cultural “foreign body removal method”. Public awareness is required to stop this potentially life threatening practice.