Журнал клинических случаев

Pharyngo Cutaneous Fistula Following Polytrauma

Abstract

Navas Nadukkandiyil, Hanadi Khamis Alhamad, Anoop Sankaranarayanan, Essa Mubarak Al sulaiti, Luay Abdel Wahab, Maryam Al Obaidely and Marwan Badri Ramadan

5-15% of patients with undiagnosed Fever of Unknown Origin have a chronic course, especially in long term care settings. It is important to identify the underlying cause as it may be secondary to more sinister underlying causes that often require an intensive and advanced diagnostic evaluation. Acute non-tuberculous retropharyngeal abscess is an infection in one of the deep spaces of the neck; it is rate in adults and usually results from local trauma, such as foreign body ingestion, or following instrumental procedures (laryngoscopy, endotracheal intubation, feeding tube placement, etc.). An esophageal perforation after anterior cervical surgery is also an uncommon but well recognized complication. Esophageal perforation and neck abscess formation are a rare complication of anterior cervical spine surgery. The causes include: (a) Oppression of the esophagus during surgery, due to a clasp held for too long causing a necrosis of the esophagus; (b) Esophagus injured by loose plates and screws. Therefore, after anterior cervical spine surgery if patients have a high fever, sore throat, swelling incision, and food sediment is was found in the incision, esophageal cutaneous fistula should be considered. The final diagnosis could be done by esophageal radiography. CT scan helps in delineating the location and condition of the implant, extent of an underlying abscess and possible extension of the abscess along the prevertebral space. We report a 31-year-old, Indian male patient who developed non-tuberculous retropharyngeal abscess during his hospital stay. The retropharyngeal abscess occurred in the context of unknown blunt trauma to esophagus and led to bilateral lower lung collapse and consolidation with secondary bronchiectasis that ultimately proved fatal. This case report describes an unusual but important cause for fever of unknown origin especially in cases where patients have Polymicrobial infections with rare offending agents particularly in patients in acute medical setting.