Pyriform sinus perforation during nasotracheal intubation: a case report

Ahmed, Mohammed Elrabie; Refaie, Bahaa Mohammed; Abdelrahman, Farghali; Ragab, Abdul-Rahman Abdul-Majeed

doi:10.1016/j.ijscr.2020.06.032

Cited by 3 publications

(1 citation statement)

References 18 publications

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“…The mucosa of the hypopharyngeal structure is extremely thin and fragile, especially in its lateral location, and poses a high risk for perforation of the pyriform sinus (Makay et al, 2008; Myers, 1982). Early diagnosis and effective treatment of perforations here can reduce the incidence of complications and improve patient survival rates (Ahmed, Refaie, Abdelrahman, & Ragab, 2020). However, if the pharyngoesophageal perforation is not recognized or the diagnosis is delayed, serious complications such as mediastinitis, retropharyngeal abscess, pneumonia, pericarditis, and death may develop (Heater & Haskvitz, 2005; Lee & Jordan, 1994).…”

Section: Discussionmentioning

confidence: 99%

When Remove the Nasogastric Tube: Before or After Endoscopy?

Çoşkun

Erdogan

Arslan

2023

Gastroenterology Nursing

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Section: Discussionmentioning

confidence: 99%

When Remove the Nasogastric Tube: Before or After Endoscopy?

Çoşkun

Erdogan

Arslan

2023

Gastroenterology Nursing

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Hypopharyngeal perforation caused by blunt trauma during consensual fellatio: an expectant management approach

Noon

Stapleton

2021

BMJ Case Rep

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Perforation of the pharynx is a rare occurrence but has the potential to cause mediastinitis and has an attendant mortality risk. Though numerous mechanisms have been described, we report a unique case of a young woman who presented with a sore throat, odynophagia and subcutaneous emphysema, a short time after performing fellatio. A contrast swallow confirmed hypopharyngeal perforation. She was managed expectantly with nasogastric feeding and empirical antibiotics. The perforation took 4 weeks to heal, but there were no residual swallowing problems at 3-month follow-up. We will explore the incidence and causes of pharyngeal perforation and discuss the options for and risks of surgical repair. This case highlights that non-surgical management of such injuries can be both safe and feasible, and reinforces the importance of ensuring confidentiality and the need for vigilance regarding potential non-consensual injury.

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Transoral traumatic perforation of the pyriform sinus by a marker pen: report of an infant case

Oyachi,

Numano,

Saito

et al. 2023

surg case rep

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Background Perforation of the pyriform sinus, included in hypopharyngeal injury, is a rare condition typically caused by iatrogenic factors. We present a case of an infant who developed deep cervical and mediastinal abscesses due to a traumatic pyriform sinus perforation caused by accidentally falling with a marker pen in the mouth. Case presentation An 11-month-old healthy male infant fell on a trampoline with a marker pen in his mouth. The patient developed swelling in the neck 3 h after the incident and was taken to a regional general hospital. Although a laryngoscopy showed no perforation in the oral cavity or posterior pharynx, a computed tomography (CT) scan revealed significant emphysema extending from the cervix to the mediastinum. The patient was transferred to our tertiary hospital and admitted to the intensive care unit, where he was mechanically ventilated, and antibiotic therapy was initiated. On day 3 of admission, a CT scan revealed deep abscesses in the cervical and upper posterior mediastinum with pneumomediastinum. Although his respiratory status stabilized and he was temporarily weaned, the fever recurred. Pharyngoesopagography revealed significant leakage of contrast from the left pyriform sinus to the mediastinum. Consequently, surgical drainage of the abscess was performed on day 10. Two low-pressure continuous suction drains were placed, one in the posterior mediastinum and the other close to the pyriform sinus. Pharyngoesophagography on postoperative day (POD) 7 demonstrated decreased contrast leakage into the posterior mediastinum. The patient was initiated on enteral nutrition through a nasogastric tube. The patient was discharged on POD 31 after the suction drains were replaced with open Penrose drains, and enteral nutrition via nasogastric tube was continued at home. The Penrose drains were removed on POD 54, and salivary leakage ceased on POD 111. Conclusions Although injuries to the oral cavity and posterior pharynx are more easily recognized, the existence of injury in the pyriform sinus can be challenging to evaluate. However, prompt and appropriate management, including intubation, antibiotic therapy, surgical drainage, and nutritional support, is critical in preventing life-threatening complications.

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Pyriform sinus perforation during nasotracheal intubation: a case report

Cited by 3 publications

References 18 publications

When Remove the Nasogastric Tube: Before or After Endoscopy?

When Remove the Nasogastric Tube: Before or After Endoscopy?

Hypopharyngeal perforation caused by blunt trauma during consensual fellatio: an expectant management approach

Transoral traumatic perforation of the pyriform sinus by a marker pen: report of an infant case

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