Pyriform sinus perforation secondary to traumatic intubation in a difficult airway patient

Lee, Tai-Shion; Jordan, John S.

doi:10.1016/0952-8180(94)90017-5

Cited by 24 publications

(13 citation statements)

References 8 publications

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“…In addition, other findings included subcutaneous emphysema and pneumomediastinum in the cervical region. If hypopharynx perforation is diagnosed late, it is likely to cause fatal complications, such as retropharyngeal abscess, mediastinitis, hematosepsis, and meningitis, which may lead to death4,8). To diagnose perforation of hypopharynx at an early stage, it is critical to examine the medical history and conduct a careful physical examination.…”

Section: Discussionmentioning

confidence: 99%

Large Perforation of Hypopharynx Secondary to Anterior Cervical Approach : A Complicated Case

Park

Yong

Kim

et al. 2013

J Korean Neurosurg Soc

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Perforation of the hypopharynx, which can occur after anterior cervical approach, is a very rare type of complication. If diagnosed late, it can lead to very fatal course, such as mediastinitis and hematosepsis. Therefore, a precise and prompt diagnosis is crucial. When conservative treatment alone is not expected to heal the perforated site or is likely to lead to serious complications, surgical treatment becomes necessary. This report demonstrates that surgical intervention performed immediately after an early diagnosis can lead to the successful treatment of a large perforation in the hypopharynx on a 58-year-old male patient.

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Section: Discussionmentioning

confidence: 99%

Large Perforation of Hypopharynx Secondary to Anterior Cervical Approach : A Complicated Case

Park

Yong

Kim

et al. 2013

J Korean Neurosurg Soc

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“…Pharyngeal perforations are even rarer, accounting for ,2% of all perforations in the pharyngoesophageal region. 12 Recognised causes of pharyngeal perforation include iatrogenic causes, blunt and penetrating trauma, spontaneous perforation, 13 swallowed foreign bodies, 15 blast injury, and emesis. 14 The commonest cause of pharyngeal perforation is iatrogenic, usually secondary to instrumentation.…”

Section: Discussionmentioning

confidence: 99%

“…14 The commonest cause of pharyngeal perforation is iatrogenic, usually secondary to instrumentation. Hypopharyngeal perforation secondary to endotracheal intubation is more likely to occur with difficult intubations, 15 in the pre-hospital setting, 16 or when performed by inexperienced anaesthetists. [17][18][19] Neonatal perforations are associated with rigid suction catheter use, 20 nasogastric 21 and endotracheal tube placement, 22 and digital trauma during resuscitation.…”

Section: Discussionmentioning

confidence: 99%

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Hypopharyngeal perforation following minor trauma: a case report and literature review

Smith

Woolley²

2006

Emergency Medicine Journal

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“…The mucosa of this hypopharyngeal structure is extremely thin and fragile, especially in its lateral portion, where only a small muscle layer separates it from the carotid sheath in the neck 2 . Its perforation is usually seen as a complication of a traumatic endotracheal intubation and is potentially lethal 3 . Most reports have consistently described operator experience 4 .…”

mentioning

confidence: 99%

Pyriform sinus perforation secondary to nasogastric tube insertion

Makay

İçöz

Akyıldız

et al. 2008

ANZ Journal of Surgery

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Pyriform sinus perforation secondary to nasogastric tube insertionThe second most common site of hypopharyngeal perforations is the pyriform sinus. 1 The mucosa of this hypopharyngeal structure is extremely thin and fragile, especially in its lateral portion, where only a small muscle layer separates it from the carotid sheath in the neck. 2 Its perforation is usually seen as a complication of a traumatic endotracheal intubation and is potentially lethal. 3 Most reports have consistently described operator experience. 4 Herein, we report a locally advanced thyroid cancer case, which to our knowledge is a previously unreported case where nasogastric tube insertion resulted in iatrogenic pyriform sinus perforation.A 42-year-old woman applied complaining of a hoarse voice of 1-year duration. On examination, thyroid masses, each 3 · 4 cm in size, in both lobes were palpated. Besides, she had an oblique scar because of previous neck surgery. She had no radiation or family history, but had a previous thyroid cancer surgery 20 years ago in another hospital. Pathology of that resected specimen showed a follicular cancer of the thyroid. She did not obey the follow-up requests. During her recent admission, ultrasound imaging showed hypoechoic solid thyroid nodules in the left and right lobe, each 3 · 4 cm in diameter. Scintigraphy showed cold nodules in both thyroid lobes. Fibre-optic laryngoscopy showed paralysis of the left vocal cord. Thyroid hormone profile was normal. Computed tomography of the thorax showed multiple metastatic nodules in both lungs. Further work-up did not show any other lesion. A palliative thyroidectomy was carried out. During surgery, because of suspicion of infiltration of a locally advanced disease, a nasogastric tube insertion into the oesophagus was requested to guide the dissection. After the tube was inserted blindly by an anaesthesia technician, the left pyriform sinus happened to be perforated accidentally. This was noted intraoperatively. The region of perforation was detected by reinserting the tube carefully. The perforation was closed primarily over a nasogastric tube without tension with absorbable sutures. Drainage of the paratracheal space was carried out. Enteral feeding through the nasogastric route was started immediately after the operation. The drainage tube was removed on the fifth postoperative day. No pharyngocutaneous fistulas were discovered. The patient had an uneventful postoperative course. She tolerated both solid food and liquids at the time of discharge and was discharged 7 days after the operation.The commonest cause of pyriform sinus perforation is iatrogenic, usually secondary to instrumentation. It is of great importance to identify this perforation during surgery because delay of the iatrogenic lesion may result in a catastrophe. It may have life-threatening consequences from retropharyngeal abscess, mediastinitis, septicaemia or meningitis. 5 If the perforation is discovered at the time of surgery, as in our case, simple and immediate suture can solve the probl...

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Pyriform sinus perforation secondary to traumatic intubation in a difficult airway patient

Cited by 24 publications

References 8 publications

Large Perforation of Hypopharynx Secondary to Anterior Cervical Approach : A Complicated Case

Large Perforation of Hypopharynx Secondary to Anterior Cervical Approach : A Complicated Case

Hypopharyngeal perforation following minor trauma: a case report and literature review

Pyriform sinus perforation secondary to nasogastric tube insertion

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