Pharyngeal Perforation Research Articles

Vomiting-induced pharyngeal perforation during bowel preparation for colonoscopy: A case report

BACKGROUND Effective bowel cleansing is essential for a successful colonoscopy. Laxatives, such as polyethylene glycol, are commonly used for bowel preparation. Vomiting is a frequent complication during bowel preparation, and forceful vomiting can potentially lead to esophageal perforation, as reported in several previous cases. However, pharyngeal perforation during bowel preparation has not been previously documented. Here, we present a case of pharyngeal perforation induced by forceful vomiting during bowel preparation. CASE SUMMARY A 38-year-old man with a history of hypertension, dyslipidemia, diabetes mellitus, and end-stage renal disease on hemodialysis was admitted for evaluation of recurrent abdominal pain. The patient complained of sudden pain in the neck, throat, and anterior chest following forceful vomiting during bowel preparation. Physical examination revealed crepitus under the skin of the neck and anterior chest on palpation, and upper gastrointestinal endoscopy revealed pharyngeal perforation. The perforation site was located above the upper esophageal sphincter, which distinguished it from Boerhaave’s syndrome. Conservative medical management was chosen after consultation with a thoracic surgeon and an otolaryngologist, considering the patient's mild symptoms, stable vital signs, and the small size of the lesion; the perforation resolved without endoscopic or surgical intervention. The patient was discharged from hospital two weeks after the perforation. CONCLUSION Despite its rarity, pharyngeal perforation should be considered a potential complication of bowel preparation for colonoscopy.

Early Detection and Urgent Surgical Repair of Pharyngeal Injury after Anterior Cervical Surgery: A Case Report

This case report addresses pharyngeal perforation, an uncommon complication after anterior cervical discectomy and fusion (ACDF). A 78-year-old male, who initially presented with quadriparesis, underwent ACDF. Post-surgery, the porridge he consumed was observed in the drain tube, leading to complications such as respiratory distress and fever. An emergency exploratory surgery was performed, and a suspected pharyngeal perforation was identified and treated with primary repair and sternocleidomastoid flap. Through thorough post-operative observation, we identified critical signs requiring immediate intervention, allowing for a successful recovery without additional complications. This report emphasizes the importance of early detection and intervention for complications following ACDF, providing valuable insights for clinical practice in neurosurgical intensive care.

Severe respiratory distress secondary to pharyngeal perforation during endoscopic gastrostomy tube removal: a clinical case report

We present the case of a 60-year-old patient with advanced chronic obstructive pulmonary disease (COPD), who presented for planned endoscopic removal of her gastrostomy feeding tube, which was inserted for nutritional status optimization prior to lung transplantation. The procedure was complicated by accidental blockage of the device at the pharyngeal level, causing a transmural laceration. Rapid respiratory distress developed with subcutaneous emphysema that led to the intubation of the patient. A new endoscopic retrieval was attempted but failed, and the patient was sent to the operating room after a cervical and thoracic CT scan that showed the blocked piece in the cervical wall, in addition to diffuse subcutaneous emphysema, a large pneumomediastinum, and a left pneumothorax. The surgery consisted of a left cervicotomy, a pharyngeal incision, and retrieval of the trapped parts. The patient was sent to the intensive care unit (ICU) where she could be weaned and extubated 1 week later.

A case report of delayed pharyngeal perforation after anterior cervical spine surgery

A case report of delayed pharyngeal perforation after anterior cervical spine surgery

Endoscopic stapler versus laser diverticulotomy for Zenker's diverticulum: a systematic review and meta-analysis.

A literature review and meta-analysis was performed to assess for difference in rate of complications and need for revision surgery between endoscopic stapler-assisted diverticulotomy and endoscopic carbon dioxide laser diverticulotomy. The hypothesis was that endoscopic stapler-assisted diverticulotomy has a lower complication rate but endoscopic carbon dioxide laser diverticulotomy has a lower need for revision surgery. This was a systematic review of English-language studies comparing endoscopic stapler-assisted diverticulotomy and endoscopic carbon dioxide laser diverticulotomy for the treatment of Zenker's diverticulum. Meta-analysis of results with regard to rate of pharyngeal perforation, major post-operative complication and need for re-operation was performed. Nine retrospective studies were included with pooled analysis of 417 endoscopic stapler-assisted diverticulotomy and 413 endoscopic carbon dioxide laser diverticulotomy cases. Meta-analysis found no significant difference in rate of pharyngeal perforation, major complication or need for re-operation between the two groups. This study demonstrated both endoscopic stapler-assisted diverticulotomy and endoscopic carbon dioxide laser diverticulotomy to be a safe alternative to open surgery for Zenker's diverticulum. Both appear to be similar in terms of adverse events and efficacy. The authors recommend either approach, guided by surgeon's preference and experience, where patients are unsuitable for an open surgery approach.

Conservative Management of a Complicated Pharyngeal Perforation Caused by Oral Blunt Trauma

In children, pharyngeal perforation is a very uncommon injury. Most of the time, it is caused by secondary instrumentation. Laceration of the pharyngeal wall poses a life-threatening risk if not detected and treated promptly. A high level of suspicion is required in such cases, so hospitalization is needed for observation until an accurate diagnosis can be made. Here, we described a case of pharyngeal perforation in a 5-year-old boy who had oral blunt trauma and developed pneumomediastinum, which we managed conservatively.

Pharyngoesophageal Damage from Hardware Extrusion at an Average of 7.5 Years After Anterior Cervical Diskectomy and Fusion: A Case Series, Discussion of Risk Factors, and Guide for Management

We present a single-institution case series of patients who experienced pharyngoesophageal damage, specifically from extruded hardware occurring at an average of 7.5 years after anterior cervical diskectomy and fusion (ACDF). A retrospective chart review was conducted of patients who had undergone ACDF with subsequent delayed pharyngoesophageal perforation or erosion from extruded hardware ≥1 year after surgery. A discussion of the literature surrounding this complication, including risk factors and management, is also presented. Nine patients were identified (average age 58 years, 66.7% male) among a total of 4122 ACDF patients (incidence: 0.22%). Average time to injury was 7.5 years. Indications for initial ACDF were degenerative cervical disease (n= 7), ankylosing spondylitis (n= 1), and cervical fracture (n= 1). Eight patients had prior multilevel ACDF spanning 2 (n= 4), 3 (n= 1), or 4 levels (n= 2). Fusion levels for prior ACDF included C5-C7 (n= 3), C3-C7 (n= 2), C4-C7 (n= 1), C4-C6 (n= 1), C2-C5 (n= 1), and C6-C7 (n= 1). Pharyngoesophageal injuries included esophageal perforation (n= 3), pharyngeal perforation (n= 2), esophageal erosion (n= 3), and pharyngoesophageal erosion (n= 1). In most (n= 6) cases, the cause of pharyngoesophageal damage was due to ≥1 extruded screws. Dysphagia (n= 8) was the most common presenting symptom. For perforations (n= 5), 2 repairs used a rotational flap to reinforce a primary closure; the other 3 cases were repaired via primary closure. Pharyngoesophageal damage caused by extruded hardware may occur several years after ACDF. These delayed complications are difficult to predict. Proper screw placement may be the most important factor for minimizing the chances of this potentially devastating complication, particularly with multilevel constructs.

Pyriform sinus rupture caused by blunt trauma

Hypopharyngeal perforation (HP) is a potentially life-threatening condition most associated with iatrogenic injury and foreign body impaction. Additionally, a number of cases of posterior HP have been reported following blunt cervical trauma. We present a case of a construction accident causing lateral hypopharyngeal rupture. Visceral perforation was initially diagnosed on computed tomography (CT) imaging and managed conservatively. We speculate this region may be particularly vulnerable to injury due to an anatomic transition in adjacent fascial support. A review of 29 prior cases suggests that this may be the first reported case of blunt trauma causing rupture of the pyriform sinus. However, significant heterogeneity exists in diagnostic approach. Radiography and CT are rapid, sensitive modalities for suggesting pharyngeal perforation, while fluoroscopy and endoscopy can better assess injury size and location and monitor resolution. Early radiologic recognition of hypopharyngeal injury is essential to initiate appropriate treatment. In certain cases, including our own, both the presence and specific location of perforation may be identified on initial CT images.

SUBCUTANEOUS EMPHYSEMA WITH AIRWAY COMPROMISE FOLLOWING OCCULT GI MICROPERFORATIONS CAUSED BY FOREIGN-BODY INGESTION

SESSION TITLE: Medical Student/Resident Imaging Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Traumatic pharyngeal perforation leading to subcutaneous emphysema following ingestion of sharp foreign objects is well described in the literature. We present the case of a man who presented in respiratory distress with evidence of extensive subcutaneous emphysema who was subsequently diagnosed with occult pharyngeal microperforations. CASE PRESENTATION: A 76-year-old man with a history of essential hypertension, type 2 diabetes mellitus, schizophreniform disorder, and multiple myeloma presented to the hospital with acute onset shortness of breath, facial swelling, dysphagia, and fever. Clinically, the patient was in respiratory distress, with evidence of stridor and with palpable crepitus extending over his neck and face. Neck and chest (Figure 1) CT showed soft tissue emphysema throughout his face and neck that extended into the mediastinum. Indirect laryngoscopy revealed diffuse pharyngeal wall and epiglottic edema, with an inability to visualize the glottis and without evidence of mural tears. The patient underwent an emergent tracheostomy given the concerns for airway compromise. Based on the initial concern of possible necrotizing fasciitis, the patient received broad spectrum antibiotics. Intraoperative biopsies of the laryngopharynx showed extensive necrosis and acute inflammation without bacterial growth. Given to the patient’s rapid clinical improvement a decision was made to hold off on emergent debridement. Barium swallow demonstrated no evidence of gastrointestinal perforation. One week after admission, the patient had a bowel movement in which he was observed to have passed numerous nuts, bolts, screws, and keys from his rectum. Abdominal imaging was performed and showed that further objects were traversing through the colon (see Figures 2–3). On questioning, the patient admitted to having ingested these objects in an attempt to aid his chronic constipation. At this point, it was determined that the consumption of these foreign bodies led to transient esophageal microperforations causing initial airway compromise. DISCUSSION: Our patient underwent traumatic pharyngeal perforation which is well described in the literature, secondary to ingestion of sharp foreign objects. Although initially it was thought that the presentation was due to a necrotizing infection, the patient’s improvement after airway management and negative culture data went against this interpretation. The subsequent passage of foreign objects and confirmatory imaging allowed us to make the final diagnosis of occult pharyngeal microperforations. CONCLUSIONS: This case emphasizes the need to approach patients based on their clinical appearance. It is important to maintain a broad differential based on the clinical presentation and to have a high index of suspicion once other possible causes have been excluded. Reference #1: Lynn De Roeck, Lauranne Van Assche, Veronique Verhoeven, Ina Vrints, Jana Van Thielen, Thierry Tondu & Filip Thiessen (2019) Progressive subcutaneous emphysema of unknown origin: a surgical dilemma, Acta Chirurgica Belgica, 119:4, 251-253, DOI: 10.1080/00015458.2018.1438560 DISCLOSURES: No relevant relationships by Jason Bofinger, source=Web Response no disclosure on file for Calli Dogon; No relevant relationships by Shahrzad Zonoozi, source=Web Response

A rare case report of laryngopharyngeal polyp formation following anterior cervical discectomy and fusion (ACDF)

BackgroundAnterior Cervical Discectomy and Fusion (ACDF) has been regarded as the “gold standard” treatment of cervical spondylosis. Though it has good outcomes, many complications still exist, such as loss of fixation, degeneration of adjacent segments, dysphagia and pharyngeal perforation. In view of current literature, this study is the first to report a case of laryngopharyngeal polyp following ACDF.Case presentationA 63 year old male patient suffered from cervical spine hyperextension after trauma accompanied by numbness of the hands and decreased muscle strength in both upper limbs. Anterior cervical fusion surgery was performed in our hospital, after which the patient’s upper limb numbness disappeared and muscle strength returned to normal. In the fifth month after surgery, the patient developed a sore throat and dysphagia. Symptoms gradually worsened, and the patient was hospitalized four times, subsequently undergoing tracheotomy, internal fixation removal, and polypectomy. The patient’s pronunciation, breathing, and swallowing functions returned to normal, and the incision healed. After a one-year follow-up, the polyp did not recur.ConclusionsLaryngopharyngeal polyp formation following ACDF has yet to be reported in literature. By excluding esophageal fistula as soon as possible, removing internal fixation and polypectomy serves as the best treatment in relieving patient symptoms.

Endoscopic mucosal incision and muscle interruption (MIMI) for the treatment of Zenker's diverticulum.

In peroral endoscopic myotomy for Zenker's diverticulum (Z-POEM), the cricopharyngeus muscle is divided within a submucosal tunnel started in the hypopharynx. We aimed to evaluate the safety and preliminary outcomes in patients who underwent a modified version of the Z-POEM where the tunnel is made directly overlying the cricopharyngeus, the mucosal incision and muscular interruption (MIMI) approach, and to compare these with patients who underwent a non-tunneled flexible endoscopic approach. All patients with ZD who were treated by flexible endoscopy at our institution between January 2015 and February 2020 were identified by a retrospective chart review. Dysphagia symptoms were assessed using a validated scoring system. Nineteen patients with ZD underwent MIMI (mean age 76.1years, 68.1% male) and seven patients underwent non-tunneled flexible endoscopic approach (mean age 64.4years, 85.7% male) during the study period. Mean ZD size was 2.8cm in the MIMI group and 1.9cm in the non-tunneled group (p = 0.03). Clinical success was achieved in 17/19(89.5%) MIMI patients and 7/7(100%) of non-tunneled flexible endoscopic patients (p = 0.101). Dysphagia scores improved in both groups, although this difference was only significant in the MIMI group (p ≤ 0.001). Recurrence occurred in 2/17(11.7%) MIMI patients and 3/7(42.9%) non-tunneled flexible endoscopic patients (p = 0.096). There were 4 complications, including one pharyngeal perforation requiring open surgical repair in a patient with a small ZD with an associated cricopharyngeal bar in the MIMI group. Median length of follow-up was 290 [142; 465] days in the MIMI group and 1056 [258; 1206] days in the non-tunneled group (p = 0.094). MIMI is a technically feasible and effective treatment for ZD. Care should be taken in patients with a cricopharyngeal bar and small ZD, as this may increase the risk of perforation. Larger studies with long-term follow-up are needed to determine if MIMI reduces the risk of symptom recurrence when compared to non-tunneled flexible endoscopic approaches.

Intracranial sewing needle in a dog

The objective of this clinical case study is to describe the first clinical case of an intracranial sewing needle identified in veterinary medicine and to describe the second case of...

Pharyngeal Perforation after Anterior Cervical Fusion Surgery

Pharyngeal perforation is a serious complication of anterior cervical fusion surgery. If it is not diagnosed in the early period and the treatment is delayed, catastrophic consequences may occur which may cause death such as septicemia, mediastinitis, pneumonia and meningitis.

2174 Endoscopic Retrograde Cholangiopancreatography Leading to Necrotizing Fasciitis: A Case Report

INTRODUCTION: Endoscopic Retrograde Cholangiopancreatography (ERCP) had become the favored method to access the pancreaticobiliary system because its a safer less invasive method compared to surgery. However, as with any procedure ERCP comes with its own risks and potential complications. We present a unique case of patient who underwent and ERCP and developed necrotizing infection of neck and a submandibular abscess. CASE DESCRIPTION/METHODS: Patient is a 66-year-old female who presented to an outside hospital with complaint of right upper quadrant abdominal pain, workup revealed choledocholithiasis. ERCP was attempted however cannulation was unsuccessful. The patient was discharged home after the procedure, but within 48 hours she presented to our institution complaining of left sided neck pain, dysphagia, and drooling. Computed tomography of the neck revealed extensive gas and fluid collections at the left submandibular space. Patient was taken to the operating room for drainage of left deep neck abscess. Drainage and irrigation of the abscess yielded streptococcus mitis. Rest of patient’s hospital course was uncomplicated and patient was discharged with appropriate follow up. DISCUSSION: ERPC is a challenging gastrointestinal endoscopic procedures. Adequate volume of procedures is required to maintain proficiency and avoid complications. Uncommon complications such as perforation are reported in <1% of case. Perforations are most commonly reported in the esophagus, stomach, duodenum, periampullary region, and bile ducts. In the case of our patient, ERCP was complicated by a perforations of the hypopharynx. The most frequent cause of pharyngeal perforation is iatrogenic due to instrumentation commonly due to the advancement of the endoscope or endotracheal tube (ETT). Pharyngeal perforation can be subclassified into supraglottic and infraglottic. The latter is more commonly associated with advancement of an ETT during intubation and presents with blood in the ETT or decreased end tidal CO2 or decreased tidal volume. Advancement of endoscope in an already intubated patient can lead to a supraglottic tear which can present with bleeding observed outside of the ETT. Patients with supraglottic or infraglottic perforations can present with similar clinical symptoms of dysphagia, fevers, oral bleeding, subcutaneous emphysema of the neck. Quick identification and treatment can decrease the morbidity and mortality in such patients.

Spontaneous pharyngeal perforation secondary to cervical osteophytosis

Spontaneous pharyngeal perforation secondary to cervical osteophytosis

An interventional radiology technique to treat pharyngeal or esophageal perforation associated with mediastinal abscess in children

PurposePharyngeal or esophageal perforation with mediastinal abscess is notably dangerous in children and can be very difficult to treat. We aimed to determine the safety and efficacy of the transnasal placement of a mediastinal drainage catheter and a nasojejunal feeding tube, with or without gastric decompression, in the treatment of the above perforations in children. MethodsWe placed transnasal mediastinal drainage catheters and nasojejunal feeding tubes in 14 pediatric patients. Patients with esophageal perforation also underwent the placement of a gastric decompression tube. Four of these patients additionally received chest drainage tubes. ResultsThe fistula healed after a median of 66 days (range, 5–404 days). Corrosive esophagitis occurred in two patients with pharyngeal perforations. One of these patients underwent surgical treatment 2 months after fistula healing, and the other underwent repeated balloon dilatation procedures for cicatricial restenosis. Four months after the fistula had healed, the patients with esophageal perforations were all free from recurrence. ConclusionThe use of interventional radiology to place a transnasal mediastinal drainage catheter, a nasojejunal feeding tube, and a gastric decompression tube is a safe, easy, inexpensive, and efficacious way to treat pharyngeal or esophageal perforation complicated by mediastinal abscess in children. Type of studyTreatment study. Level of evidenceLevel IV.

Successful Surgical Treatment for Pharyngeal Perforation in a Patient with Aortic Valve Infectious Endocarditis

Successful Surgical Treatment for Pharyngeal Perforation in a Patient with Aortic Valve Infectious Endocarditis

Traumatic pharyngeal perforation secondary to a syndesmophyte

We report the case of a 57-year-old man who presented at the emergency department with injuries to his face and head after falling down the stairs. A head computed tomography examination done because he complained of an intense headache revealed air bubbles in the retropharyngeal space. Given this finding, a computed tomography of the neck was done to evaluate the possibility of pharyngeal perforation.Traumatic pharyngeal perforations are uncommon, but those caused by the calcification of the anterior longitudinal ligament, as in our case, are even more uncommon.

A simple technique for easier anterior odontoid screw fixation

Background: Anterior odontoid screw fixation (AOSF) is an osteosynthetic technique used for fixation of type 2 and rostral type 3 odontoid fractures. Compared to other treatment modalities, it provides immediate stability, preservation of the majority of the remaining C1–2 motion and an achieved union rate of 80–100%. AOSF requires a stable and reduced odontoid to allow for placement of guide wire and cannulated screw. Image guidance with neuro-navigation or intraoperative fluoroscopy are used for accurate placement of instrumentation. Minimally invasive techniques have been described, such as endoscopic or percutaneous placement of odontoid screws and the use of tubular retractor system. Major site-specific complications include neural injury, esophageal or pharyngeal perforation, hemorrhage, and airway obstruction.Purpose: To assess safety and efficacy of a new simple technique developed by the Authors for insertion of the odontoid screw through a less invasive anterior approach.Study design: Prospective case seriesMethods: Eight patients, 7 males, with odontoid fractures were treated with AOSF under fluoroscopic guidance between January 2014 and October 2015. The operation was successfully completed without technical difficulties using a beveled bone marrow biopsy needle (Jamshidi needle) as a sleeve for guide wire insertion.Results: No soft tissue complications such as esophageal or neuro-vascular injury occurred. Intraoperative bleeding was 25 mL on average. The operation time averaged 75 min. All of the screws were placed in good positions. After a mean follow-up of 12.1 months (range 8–18 months), radiographic fusion was documented for 7 of 8 patients (87.5%). Neither clinical complications nor hardware loosening or breakage occurred.Conclusion: Our short term clinical results suggest that the new less invasive anterior odontoid screw fixation procedure using a Jamshidi needle and fluoroscopy is technically easy with good clinical and radiological results.

Subcutaneous Emphysema in Peri-Operative Period – An unusual case

Pharyngeal perforation is a rare serious finding with fatal outcomes if not diagnosed and managed promptly(1). The main cause is an iatrogenic injury during pharyngeal instrumentation and commonly present with neck pain, swelling, and subcutaneous emphysema. Many predisposing factors played a major role like difficult instrumentation, pharyngeal infection and old age(2). In our case, we present a patient with prostate cancer who underwent radical prostatectomy and was found to have mediastinal and surgical emphysema.