Retropharyngeal sinus tract secondary to glass shard impaction in an 8 month-old child; endoscopic diagnosis via telescope endoscopy and management of sinus tract by endoscopic electrocauterization.
- Author:
Angelo Miguel P. Parungao
1
;
Antonio H. Chua
2
Author Information
- Publication Type:Journal Article
- Keywords: foreign body impaction; endoscopic cauterization; sharp pointed foreign body
- From: Journal of the Philippine Medical Association 2020;99(1):36-41
- CountryPhilippines
- Language:English
-
Abstract:
OBJECTIVES:•To present a case of an 8 month-old female
who ingested a foreign body that impacted
itself into the posterior pharyngeal wall
resulting in a retropharyngeal sinus tract
• To discuss the events leading to the
diagnosis of the patient
• To explain the reason behind the difficulty of
locating the foreign body during rigid
esophagoscopy
• To discuss the use of endoscopic
cauterization as management of the
retropharyngeal sinus tract
METHODS:Design: Case Report Setting: Tertiary Government Hospital Patient: One
RESULTS:An 8 month-old female presented with repeated bouts of vomiting with associated refusal to eat. A chest radiograph showed a triangular radiopaque object at the level of Tl -T2. Emergency foreign body extraction via rigid esophagoscopy was done, however, no foreign body was seen in the esophagus. An intraoperative chest radiograph showed a foreign body at the previously described location. On repeat esophagoscopy, a linear wound with purulent discharge on the posterior pharyngeal wall was seen. This wound was explored using a 0° telescope revealing a retropharyngeal tract measuring 2.4 cm in length. At the end of the retropharyngeal tract, a glass shard was found and was extracted. This tract was monitored endoscopically 4, 18, 25, and 32 days postoperative, respectively for possible spontaneous closure of the tract. Eventually, after 32 days, noted to persist hence was debrided and was cauterized via electrocautery leading to its closure. Postop monitoring via flexible endoscopy and neck soft tissue lateral x-ray showed complete closure of the retropharyngeal sinus tract.
CONCLUSION:An 8 month-old female who ingested a glass shard was presented. The ingestion of pointed or sharp objects may be embedded into the retropharyngeal space and its further advancement may be caused by shearing forces caused by repetitive swallowing and vomiting. Immediate detection of these sharp foreign bodies may prevent formation of such tracts. Therefore, a high index of suspicion must be had in cases where foreign bodies that are not visualized by rigid esophagoscopy by careful inspection of the mucosal wall of the pharyngeal area with further guidance of radiographs. The innovation of endoscopic electrocautery as management of the sinus tract, inspired from the management of fourth branchial cleft sinus tracts, is an effective approach in management. - Full text:Retropharyngeal sinus tract secondary.pdf
