食管异物并发食管穿孔及颈部脓肿临床分析

目的：探讨食管异物并发食管穿孑L及颈部脓肿的临床特点及治疗方法,以期提高对该病的诊治水平。方法：24例食管异物并发食管穿孔及颈部脓肿患者均在全身麻醉下行食管镜检查异物取出术,其中经食管镜取出异物14例,开胸后取出义齿3例,颈侧切开取出异物5例;余2例未见异物。结果：24例患者中并发脓肿16例,其中食管周围脓肿10例,颈部脓肿4例,纵隔脓肿2例;治愈21例,死亡1例,1例因血糖高转内分泌科,1例转胸外科继续治疗。结论：早期诊断、早期治疗是处理食管异物并发食管穿孔的关键。对于食管异物并发食管穿孔及颈部脓肿患者行薄层CT扫描具有极高的诊断及鉴别诊断价值。颈部脓肿一经确诊,应及时行脓肿切开引流术,合理应用抗生素,有效控制感染及并发症的发生,加强营养支持治疗可提高治愈率。     

儿童咽后脓肿48例临床诊治分析

目的总结儿童咽后脓肿的临床特点、诊断及治疗方法。方法回顾性分析深圳市儿童医院2003年7月～2011年5月收治的咽后脓肿患儿的临床症状、治疗方法及预后。结果 48例患儿入院后均行脓肿切开排脓术,术后常规应用抗生素治疗,患儿全部治愈出院。结论咽后壁脓肿患儿有颈部活动受限,特别是不能后仰,部分患儿可发生呼吸困难或喉喘鸣;CT扫描对诊断咽后脓肿有重要价值;如确认脓腔形成,则应行脓肿切开排脓术。     

咽后脓肿临床诊治分析

目的探讨咽后脓肿的临床表现及治疗方法。方法对31例咽后脓肿的临床资料进行回顾分析。18例（58.1%）继发于咽异物损伤,7例（22.6%）继发于急性化脓性扁桃体炎及喉炎,4例（12.9%）继发于上呼吸道感染,2例（6.5%）原因不明。全部病例行颈部X线平片检查,表现为咽后肿胀型7例,液平型13例,液气型11例。其中9例发现喉咽异物残留。27例经口行咽后脓肿切开＋置管引流,4例保守治疗。结果 28例治愈,3例并发纵膈脓肿及肺脓肿感染性休克死亡。结论咽异物损伤是咽后脓肿的主要诱因。颈部X线片分型对诊断及治疗预后有重要价值。经口咽后脓肿切开＋置管引流是一有效治疗方法。应重视对严重并发症的早期认识及处理。     

小儿咽后脓肿14例临床分析

报告14例小儿咽后脓肿,急性型13例,慢性型1例;异物性2例,结核性1例,邻近炎症扩散引起者2例,上呼吸道感染所致9例;14例颈侧位X线片示脓肿2例,10例颈部CT扫描示脓肿7例.所有病例经脓液引流及抗炎或抗痨治疗后痊愈.     

咽喉部鱼刺异物迁移致颈部脓肿分析

目的　探讨咽喉部鱼刺异物迁移致颈部脓肿的临床特征、辅助检查、治疗手段及预防策略。方法　回顾性分析8例咽喉部鱼刺异物迁移致颈部脓肿的临床资料。结果　7例有异物误咽史。2例鱼刺迁移至胸锁乳突肌内,3例至舌骨舌肌内,1例至甲状软骨上角与颈动脉鞘之间,1例至咽后间隙,1例至甲状腺内侧。6例行彩色B超检查,5例发现异物。所有患者均行颈部CT检查,4例发现异物。全部患者均通过颈外侧入路颈部探查取出异物。结论  对伴有异物吞咽史的颈部脓肿患者首先考虑异物迁移。彩色B超检查有明确价值,薄层CT及三维重建可作为补充检查手段,手术为首选。医疗安全教育、提高医患警惕为主要预防手段。     

儿童尖锐性食管异物

目的探讨儿童尖锐性食管异物的临床特点及治疗方法。方法1965年～2003年38年里共收治14岁以下儿童食管异物359例,其中尖锐性食管异物36例,按异物种类、停留部位、并发症、麻醉和手术方法等对此36例进行回顾分析。结果36例异物中鱼骨1例,边缘锐利的金属片10例,枣核21例,塑料五角星2例,玩具小飞机1例,铁丝1例。异物滞留部位均于食管入口处。经表面麻醉食管内窥镜下取出10例,全麻食管内窥镜下取出24例,颈侧切开取出2例。并发食管穿孔4例(继发纵隔脓肿1例),咽后壁脓肿2例,有呼吸困难发生者7例。结论全麻下经硬管食管内窥镜取出是治疗食管尖锐性异物的主要方式,对于食管入口处难取性尖锐食管异物应及早采取颈侧切开途径取出。     

老年呼吸道异物的临床特点和围手术期处理

目的 探讨老年呼吸道异物的临床特点及围手术期处理方法。方法 回顾性分析9例老年呼吸道异物患者的临床资料,总结此类患者临床特点及恰当的围手术期处理方案。结果 9例中4例首诊于呼吸内科,其中3例行纤维支气管镜检查确诊后转入我科;在表面麻醉加静脉复合麻醉下经口行支气管镜检查取出7例,在表面麻醉下经气管切开口行支气管镜术取出2例,术后无并发症发生。结论 老年人肺部感染性病变经抗感染治疗后反复不愈者,应警惕呼吸道异物;CT扫描有助于老年呼吸道异物的诊断;支气管镜术是治疗老年呼吸道异物的主要方法。     

颈深部多发性脓肿伴咽瘘2例临床分析

目的探讨颈深多发性脓肿伴咽瘘的临床特点及治疗方法,以提高诊治水平。方法对我院2009年收治的2例颈深部多发性脓肿伴咽瘘的患者的临床资料进行回顾性分析。结果2例患者经抗感染、脓肿切开引流和局部换药治疗痊愈。结论颈深部脓肿合并喉咽瘘者鼻饲饮食和选择即时切开引流是治愈成功的关键。     

颈侧切开术在颈段食管异物取出中的应用

目的探讨颈侧切开术治疗颈段食管异物的适应证和临床诊疗要点。方法回顾性分析2001年1月～2011年3月行颈侧切开术治疗25例颈段食管异物患者临床资料。25例患者中21例发生食管穿孔,其中食管穿孔并发颈部脓肿18例,3例为贯穿性异物未并发颈部脓肿;嵌顿性颈段食管异物4例。结果 25例患者均经颈侧切开手术治疗后痊愈出院。3例患者出现声音嘶哑,2例患者半年内恢复,1例未恢复。2例气管切开者均在住院期间拔除气管套管。结论颈段食管异物穿孔并颈部脓肿形成和贯穿性异物和嵌顿性异物经食管镜未能取出者应为颈侧切开术良好适应证。     

咽及食管腔外异物24例临床分析

目的：总结咽及食管腔外异物的临床特征、诊断和治疗经验。方法：回顾性分析24例咽及食管腔外异物患者的临床资料。结果：22例手术取出异物,1例异物自动排出,1例死亡。结论：咽、食管腔外异物临床少见,在有异物史后,如患者发生呕血、腔外邻近间隙积血,或腔外组织间隙有顽固性炎症反应及脓肿,均表示有腔外异物的可能,影像学检查是主要诊断手段,一旦确诊,应及时处理,手术是惟一有效的治疗方法。     

Transcervical foreign body

The uncommon occurrence of acute retropharyngeal abscess in adults can be the result of a retained foreign body. A large piece of wood impacted in the neck in a road traffic accident and presenting as retropharyngeal and bilateral parapharyngeal abscesses is reported for its rarity and clinical interest.     

Retropharyngeal abscesses: a clinical and radiologic correlation.

OBJECTIVE: This study evaluates the efficacy at our centre of the lateral neck x-ray and the computed tomography (CT) scan in differentiating retropharyngeal cellulitis from abscess in retropharyngeal space inflammatory process. METHOD: We reviewed the medical records of 37 patients with the diagnosis of retropharyngeal abscess or cellulitis hospitalized at the Centre Universitaire de Santé de l'Estrie in Sherbrooke between 1986 and 1997. Patients with a positive drainage at surgery were considered as retropharyngeal abscess and the rest as cellulitis. We measured the sensitivity, specificity, and positive and negative predictive values for the lateral neck x-ray and CT scan. Demographic and clinical data were also extracted for each patient. RESULTS: Twenty-five patients were classified as retropharyngeal cellulitis and only six patients as retropharyngeal abscess, although 13 patients went to the operating room for drainage. Results for the sensitivity and specificity were 80% and 100% for the lateral neck x-ray and 100% and 45% for the CT scan. Positive and negative predictive values for lateral neck x-ray were 100% and 94%, respectively. Forty percent and 100% were the values calculated for the CT scan. Clinical data were consistent with what has been reported in the literature. CONCLUSION: CT scan is helpful in the management of retropharyngeal abscess but has limits in differentiating cellulitis and abscess. Lateral neck x-ray was found to be very specific when the air sign was present.     

A sterile acute retropharyngeal abscess

A 12-year-old male admitted to ENT ward on an emergency basis with history of foreign body in throat. It came out along with induced vomiting, followed by fever, Odynophagia and restricted Neck movements. It is proved as a case of acute retropharyngeal abscess. But it turned out to be the sterile abscess, which is rare and new thing for us. Hence presented herewith-brief review of literature.     

Airgun pellet injuries of the neck

Penetrating injuries of the neck are a cause of retropharyngeal abscess. Should a foreign body become lodged in the retropharyngeal tissues its removal may avoid this complication, but surgery can in itself be hazardous. Between 10 and 15 per cent of cases of retropharyngeal cellulitis resulting from whatever cause do not progress to abscess formation if treated conservatively. Consequently, it is important to have evidence of abscess formation before surgery is undertaken, as illustrated by this paper in the form of a case report and a review of the current literature.     

Retropharyngeal abscess: An unusual presentation of Kawasaki disease. Case report and review of the literature

We report the case of a patient with Kawasaki disease whose initial presentation mimicked a retropharyngeal abscess and review the literature of this topic (16 cases reported). Fever and deep neck infection like symptoms were the only clinical findings at admission in 87.5% children. All children had a neck CT scan performed showing findings suggestive of retropharyngeal abscess. All children were started antibiotic therapy without clinical improvement and 31% of patients underwent unproductive surgical drainage of the retropharyngeal space. Otolaryngologist should be aware of atypical presentation of Kawasaki disease presentation mimicking retropharyngeal abscess. Early diagnosis is pivotal for preventing cardiac complications and avoiding the risk associated to unnecessary surgical intervention.     

Retropharyngeal abscess: report of 2 cases

Retropharyngeal abscesses are uncommon and their frequency has decreased since the development of antibiotics. It is important to recognize this serious condition in order to begin treatment promptly. The causes of these processes differ in children and adults, as do the symptoms of presentation. Lateral cervical radiography and CT are diagnostic in only a few cases. Treatment is abscess drainage. Two cases of retropharyngeal abscess are reported. The first case occurred in a child and was due to infection of Waldeyer's lymphatic ring. The second occurred in an adult as a result of foreign body trauma.     

A case of spinal epidural abscess associated with retropharyngeal abscess

Spinal epidural abscesses are known to occur associated with retropharyngeal abscess, but such cases are few in the literature. We treated a 72-year-old woman who reported pain in the back of the neck. Computed tomography (CT) showed a retropharyngeal abscess extending to the upper neck through the carotid space on the left side and an magnetic resonance imaging (MRI) showed a spinal epidural abscess without cervical vertebral osteomyelitis. The abscess was assumed to reach the epidural space along the nerve root through the intervertebral foramen. Since tonsillitis appeared to cause the retropharyngeal abscess, we performed tonsillectomy, and then drained pus through the superior constrictor muscle, effecting a subsequent cure. Staphylococcus aureus was recovered from both the pus and tonsil, and Streptococcus constellatus, a member of the Streptococcus milleri group, from the tonsil. Based on a review of the literature, clinical courses of spinal epidural abscess associated with retropharyngeal abscess are not always simple, as 4 of the 7 cases found demonstrated poor prognosis. Spinal epidural abscess should be considered a critical complication of retropharyngeal abscess.     

Uncommon position of a retropharyngeal impacted fishbone

The case of a 34-year-old otherwise healthy woman with retropharyngeal abscess due to a fishbone injury and presenting with neck stiffness and aphagia without visualization of a pharyngeal mucosal lesion is reported. The case illustrates that sore throat with symptoms out of proportion to oropharyngeal findings should prompt a search for pathologies other than simple pharyngotonsillitis. Other typical symptoms of a retropharyngeal abscess are high fever, dysphagia, hot potato voice and, less commonly, dyspnea and sepsis. Retropharyngeal abscess in adults occurs most often as a complication of a spread of infection from a pharyngeal focus, a foreign body injury, an iatrogenic trauma due to tracheal intubation or endoscopy, and blunt or perforating neck trauma. Contrary to children, a retropharyngeal abscess in adults without loco-regional infection or preceding trauma is very rare. This case illustrates how important imaging investigations (CT-scan) are in order to locate foreign bodies and to decide on surgical management. Aetiology, presenting signs, symptoms, methods of diagnosis, treatment and complications of a retropharyngeal abscess are briefly discussed.