Unerkannte Hypopharynxperforation mit tiefem Halsabszess und Mediastinitis infolge trans�sophagealer Echokardiographie

Abstract

Hypopharyngeal perforation is a rare but dangerous complication caused by diagnostic procedures. If there is any suspicion of perforation of the upper airways and/or upper digestive tract, immediate diagnostic and therapeutic procedures are indicated. Possible complications of a hypopharyngeal perforation are deep neck infection with subsequent mediastinitis and haemorrhage from major cervical vessels, both of which have high mortality rates. We present the case of a 65 year old male patient with perforation of the hypopharynx after transesophageal echocardiography which was unrecognized for more than 1 week. Clinical symptoms of hypopharyngeal perforation may initially be unspecific. Esophagography (Gastrografin administration) and computed tomography as well as esophagoscopy are needed to certify the diagnosis and to evaluate the extent of the lesion. Pathological findings as well as diagnostic and therapeutic needs are demonstrated and discussed.

Rigid Laryngoscope-assisted Insertion of Transesophageal Echocardiography Probe Reduces Oropharyngeal Mucosal Injury in Anesthetized Patients

“…[1][2][3][4][5][6] Fortunately, most complications are either minor mucosal injuries or bleeding. However, more serious cases such as arytenoid dislocation, 7 esophageal perforation, 8 hypopharyngeal perforation with abscess, and mediastinitis 9 have been reported. TEE insertions in anesthetized patients are more difficult than those performed in conscious patients because oral passages are obstructed.…”

Spontaneous pharyngoesophageal perforations

“…Usually, these lesions can be managed nonsurgically [1,2,7]. However, spontaneous pharyngeal perforation is rare and has never been reported as a complication of deep neck infection.…”

“…Pharyngeal perforation or esophageal perforation often derives from iatrogenic procedures and results in devastating outcomes without caution [1,2]. However, concurrent perforations of pharyngoesophagus are rare, and usually follow the barotrauma of an explosion; spontaneous pharyngeal perforation has seldom been mentioned in the literature [2][3][4].…”