This case report highlights the effectiveness of Videofluoroscopic Swallowing Study-guided balloon dilation in managing dysphagia resulting from subclinical recurrent laryngeal nerve (RLN) neuropathy after a non-lethal hanging attempt. A 71-year-old male presented with dysphagia following an attempted hanging. The initial assessments revealed neck pain, soft tissue edema, and a fractured hyoid bone. Despite stable respiratory findings, the patient had significant swallowing difficulties. The patient underwent a VFSS that revealed an upper esophageal sphincter (UES) dysfunction linked to bilateral RLN neuropathy. After conventional dysphagia therapy, VFSS-guided balloon dilation was performed on day 46 after a tracheostomy. Following the procedure, significant improvement in swallowing function was noted, with the Penetration–Aspiration Scale (PAS) score decreasing from 5 to 2. The intervention was well-tolerated, with no significant adverse events reported. VFSS-guided balloon dilation is a safe and effective treatment option for dysphagia caused by an impaired UES opening resulting from subclinical RLN neuropathy after hanging. Further studies with larger populations will be needed to validate these findings and refine the treatment protocols.

The sciatic nerve can be injured through various mechanisms, including direct compression and ischemia related to traumatic events. Reports of iatrogenic sciatic nerve injury caused by misplaced intramuscular injections are rare. We present a case involving a 5-year-old patient who developed motor weakness and hypesthesia in the left lower extremity following an intramuscular injection of diclofenac into the left buttock. An electrodiagnostic study diagnosed the patient with an injury to the left sciatic nerve, primarily affecting its peroneal division. This diagnosis was later confirmed by radiologic evaluation. Following several weeks of rehabilitation, which included gait pattern correction, verbal cueing, and electrical stimulation therapy, the patient showed improvement in sensory deficits and motor impairment. The peroneal portion of the sciatic nerve is more susceptible to injury than the tibial portion due to its structural characteristics. Additionally, the sciatic nerve follows various paths as it passes the piriformis muscle. Certain drugs, such as diclofenac, exhibit greater neurotoxicity than others. When neurologic deficits are observed, an electrodiagnostic study is recommended. This helps not only in identifying the etiology and precise location of the neural insult but also in predicting the prognosis and formulating a comprehensive treatment plan.

Dysphagia aortica is a rare form of mechanical dysphagia characterized by extrinsic compression of the esophagus by the aorta. A 69-year-old male reported experiencing swallowing difficulties for five months, along with nausea, abdominal discomfort, weight loss, and severe reflux. Considering his age and a medical history of hypertension and stenosis of the cerebral artery, poststroke dysphagia was initially suspected. However, brain magnetic resonance imaging revealed no evidence of acute or subacute stroke. Further evaluation was achieved via enhanced chest computed tomography to locate the focus of the systemic inflammation. A thoracic aortic aneurysm about 8.7×5.0 cm in size, with signs of impending rupture, was observed. This case reinforces that a high possibility for dysphagia aortica should be considered under conditions of unclear etiology of dysphagia but the presence of associated symptoms, such as progressive intolerance to solids and ultimately to liquids, weight loss, and nausea.

BACKGROUND: Endovascular aortic aneurysm repair (EVAR) has come into use and been widely extended because of the low complication rate and less-invasiveness. This article aimed to describe our experience in the treatment of abdominal aortic aneurysm with EVAR. MATERIALS AND METHODS: A retrospective review was conducted for the 22 patients who underwent EVAR in a single hospital December 2001 to June 2009. RESULTS: The mean age of the patients was 68.5+/-7.6 years. There were several risk factors and comorbidities in 20 patients (90.9%). The mean diameter of the aortic aneurysms was 61.2+/-12.9 mm. The mean length, diameter, and angle of the aneurysmal neck were 30.5+/-15.5 mm, 24.0+/-4.5 mm, and 43.9+/-16.0degrees, respectively. The mean follow-up period of the patients was 28.8+/-29.5 months. The 30-day postoperative mortality was none. Seven patients (31.8%) had endoleaks during the hospital stay and three patients (13.6%) had endoleaks during the follow-up period. One patient (4.5%) died due to a ruptured aortic aneurysm. The cumulative patient survival rates were 88.2%, 88.2%, and 70.6% at 1, 3, and 5 years of follow-up, respectively. CONCLUSION: EVAR is currently a safe, feasible procedure for high risk patients with abdominal aortic aneurysm because of low postoperative complication and mortality if patients are selected properly and followed up carefully.
Aneurysm ; Aorta, Abdominal ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal ; Aortic Rupture ; Comorbidity ; Endoleak ; Follow-Up Studies ; Humans ; Length of Stay ; Neck ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Survival Rate