Factors affecting perforation of the esophagus in patients with deep neck infection

Background

Deep neck infection (DNI) is a serious disease that can lead to severe morbidity, including esophageal perforation, and mortality. However, no previous study has explored the risk factors associated with esophageal perforation in patients with DNI. This study investigated these factors.

Methods

Between September 2015 and September 2021, 521 patients with DNI were studied. Relevant clinical variables and deep neck spaces were assessed.

Results

In a multivariate analysis, involvement of the retropharyngeal space (OR 5.449, 95% CI 1.603–18.51, p = 0.006) and the presence of mediastinitis (OR 218.8, 95% CI 55.98–855.3, p < 0.001) were independent risk factors associated with esophageal perforation in patients with DNI.

There were no differences in pathogens between 32 patients with and 489 patients without esophageal perforation (all p > 0.05).

Conclusion

Involvement of the retropharyngeal space and the presence of mediastinitis were independent risk factors associated with esophageal perforation in patients with DNI. There were no differences in pathogens between the groups with and without esophageal perforation in DNI.

Migrating fish bone presenting as a neck fistula

The case report describes an extremely rare finding of fish bone migration from the aerodigestive tract causing a neck fistula 2 years after its ingestion. Detailed case study and surgical treatment is presented. This case highlights the need for further assessment in presence of a high clinical suspicion of foreign body ingestion with a normal physical examination of the upper aerodigestive tract, to avoid serious and potential life-threatening complications later on.

Internal drainage of retropharyngeal abscess secondary to esophageal foreign bodies: a case series

INTRODUCTION AND OBJECTIVES

Foreign body oesophagus is a commonly seen emergency in ENT. It is seen both in children and adults. When sharp bony foreign bodies such as chicken, fish, and mutton bone gets impacted in the oesophagus, it predisposes the patient to various complications. The foreign body can migrate extraluminally with time and cause retropharyngeal abscess.

MATERIALS AND METHODS

Retrospective study over a period of 6 months from November 2019 to April 2020 of patients with foreign body oesophagus. We came across 20 patients with oesophageal foreign bodies and five of them had associated retropharyngeal abscess. Rigid esophagoscopy with foreign body removal and internal drainage of pus through the oesophageal rent followed by conservative management with intravenous antibiotics based on culture and sensitivity was done.

RESULTS

Patients improved drastically as the pus drained into the oesophagus via the rent in the posterior oesophageal wall and did not require an external incision and drainage. They were discharged in a week.

CONCLUSION

Removal of partial extraluminally migrated foreign body oesophagus and internal drainage of the abscess followed by nasogastric feeds till the rent resolves and intravenous pus culture-sensitive antibiotics fastens patient recovery and reduces the morbidity associated with external incision and drainage and oesophageal rent repair.

Acute thyroid abscess secondary to oesophageal perforation

Acute thyroid abscess is rare, however this report describes the case of a 71-year-old male with an acute thyroid abscess resulting from oesophageal perforation who was successfully treated with antibiotic (cefotaxime sodium), neck exploration and a right subtotal thyroidectomy. The patient reported ingesting a fish bone and, although this had been dislodged, he experienced continuing pharyngalgia and fever. An anterior neck swelling with tenderness and erythema was noted at the level of the right thyroid. At operation, the recurrent laryngeal nerve was identified and preserved, and a large part of the right thyroid was excised. During the 5-year follow-up period, deglutition function and thyroid function tests remained normal. This result indicates that early administration of antibiotic, and surgical treatment of the infection source and affected thyroid tissue are critical for a successful outcome and the prevention of severe complications.

Esophageal foreign body as a cause of upper gastrointestinal hemorrhage: case report and review of the literature

Foreign body ingestion is a common complaint in the emergency department. Severe upper gastrointestinal (GI) hemorrhage is a rare complication of foreign body ingestion and is always considered to signal aortoesophageal fistula (AEF). We report a rare case of a 65-year-old man with upper GI hemorrhage caused by an ingested duck bone 10 days previously. Instead of AEF, massive erosion and edema were found in the esophagus, highlighting the potentially complex pathology of foreign body ingestion. A literature review of the recognized clinical features of esophageal foreign body is described. Some practical points and pitfalls in the management of esophageal foreign body are presented. For patients with a history of esophageal foreign body ingestion, the clinician must maintain a high index of suspicion and must endeavor to obtain a full history.

An unusual complication of dental radiography: Case report

We present the case of a 46-year-old man who was undergoing a routine dental examination when a radiograph film plate became lodged in his upper aero-digestive tract. The foreign body was successfully removed in the ENT department of the local hospital without significant harm being done. The case highlights the potential risks of even the simplest procedures, and makes a good argument for using radiograph film holders, when possible.