Esophageal perforation and neck abscess from ingested foreign bodies: treatment and outcomes.Abstract Over a 6.5-year period, 5,848 patients who had ingested in·gest tr.v. in·gest·ed, in·gest·ing, in·gests 1. To take into the body by the mouth for digestion or absorption. See Synonyms at eat. 2. a foreign body were admitted to the ENT ENT ears, nose, and throat (otorhinolaryngology). ENT abbr. ear, nose, and throat ENT ear, nose and throat. ENT Ears, nose & throat; formally, otorhinolaryngology unit at the Prince of Wales Hospital
n. 1. The act of perforating or the state of being perforated. 2. An abnormal opening in a hollow organ or viscus, as one made by rupture or injury. Perforation A hole. . Patients on the conservative regimen were administered intravenous broad-spectrum antibiotics and were not permitted to take any food or liquids by mouth; they received their nutrition via either enteral enteral /en·ter·al/ (en´ter'l) enteric. en·ter·al adj. 1. Within or by way of the intestine, as distinguished from parenteral. 2. Enteric. feeding or total parenteral nutrition Total Parenteral Nutrition Definition Total parenteral nutrition (TPN) is a way of supplying all the nutritional needs of the body by bypassing the digestive system and dripping nutrient solution directly into a vein. . Conservative treatment was successful in all seven patients with a perforation and no abscess and in the one patient with an abscess who refused surgery. Moreover, all four patients who underwent surgical treatment recovered. Our experience demonstrates that esophageal perforation related to an ingested foreign body can be safely treated by conservative means if the diagnosis is made before significant contamination occurs. Conversely, abscesses (cervical or mediastinal mediastinal /me·di·as·ti·nal/ (-as-ti´n'l) of or pertaining to the mediastinum. mediastinal of or pertaining to the mediastinum. ) related to an ingested foreign body should be explored and surgically drained. Introduction Ingested foreign body is a common clinical problem in Hong Kong, primarily because it is a consequence of long-standing local cooking and eating habits. Major complications--including esophageal perforation, deep neck abscess, and (in rare cases) esophagoaortic fistula--have been reported in 0.5 to 1.0% of such patients in Hong Kong. (1,2) Esophageal perforation is associated with significant morbidity and mortality Morbidity and Mortality can refer to:
v 1. made radioactive by the addition of small quantities of radioactive material. 2. made contaminated by adding infective or radiographic materials. 3. an infective surface or object. area. (3-5) Nevertheless, satisfactory results have also been reported with conservative approaches. (6-8) The development of abscesses in the deep neck spaces and the mediastinum mediastinum /me·di·as·ti·num/ (me?de-ah-sti´num) pl. mediasti´na [L.] 1. a median septum or partition. 2. following foreign-body ingestion ingestion /in·ges·tion/ (-chun) the taking of food, drugs, etc., into the body by mouth. in·ges·tion n. 1. The act of taking food and drink into the body by the mouth. 2. can occur in the absence of any clinical evidence of esophageal perforation. We reviewed a large number of cases of ingested foreign bodies. In this article, we describe our findings with respect to the diagnosis, management, and outcomes of those patients who experienced potentially serious complications of foreign-body ingestion. Patients and methods We audited the hospital records of 5,848 patients who had been admitted to the ENT unit at the Prince of Wales Hospital in Hong Kong between July 1, 1987, and Dec. 31, 1993, with a complaint of an ingested foreign body. We reviewed the case notes of all patients who had stayed in the hospital at least 4 days, all patients who were readmitted within 1 month, and all patients who required esophagoscopy. More than 600 patients fulfilled at least one of these criteria. A total of 169 had been hospitalized for 4 days or longer because of social or concurrent medical problems. Two patients, both Vietnamese refugees, had been readmitted within 1 month; both declined esophagoscopy and were discharged after 2 days of uneventful observation. Either diagnostic or therapeutic esophagoscopy had been performed on 519 patients (8.9%); 441 underwent rigid esophagoscopy and 78 flexible esophagoscopy. Results Among the 5,848 patients, major complications developed in 12 (0.21%)--five males and seven females, aged 8 to 79 years (mean: 44). Eight patients (0.14%) had an esophageal perforation (table 1) and four (0.09%) presented with a retropharyngeal abscess retropharyngeal abscess ENT A disease of children < age 5, in which posterior throat tissue is susceptible to abscess formation, accompanied by high fever, severe sore throat, dysphagia and dyspnea, which may be life threatening. Cf Strep throat. (table 2). All 12 patients had undergone rigid rather than flexible esophagoscopy. Esophageal perforation. We classified the perforation patients into three groups according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. the timing of their diagnosis: Group 1. Patients 2, 5, and 6 were diagnosed with an esophageal perforation at presentation on the basis of obvious radiologic signs. All had sought treatment within 24 hours of foreign-body ingestion. These perforations were at or above the level of the cervical esophagus esophagus (ĭsŏf`əgəs), portion of the digestive tube that conducts food from the mouth to the stomach. When food is swallowed it passes from the pharynx into the esophagus, initiating rhythmic contractions (peristalsis) of the . Group 2. Patients 1 and 7 had iatrogenic iatrogenic /iat·ro·gen·ic/ (i-a´tro-jen´ik) resulting from the activity of physicians; said of any adverse condition in a patient resulting from treatment by a physician or surgeon. perforation of the cervical esophagus diagnosed during esophagoscopy. Group 3. Patients 3, 4, and 8 had iatrogenic perforations that were not noticed during rigid esophagoscopy. Perforation did not become evident until afterward, when they developed persistent pain, fever, and/or leukocytosis Leukocytosis Definition Leukocytosis is a condition characterized by an elevated number of white cells in the blood. Description Leukocytosis is a condition that affects all types of white blood cells. . In addition, patient 4 later developed both a retropharyngeal retropharyngeal /ret·ro·pha·ryn·ge·al/ (-fah-rin´je-al) 1. pertaining to the posterior part of the pharaynx. 2. posterior to the pharynx. ret·ro·pha·ryn·geal adj. and a mediastinal abscess. Treatment. Initially, all eight patients were managed conservatively. They received broad-spectrum antibiotics intravenously and they were prohibited from taking any food or liquids by mouth; they received their nutrition via either enteral feeding or total parenteral nutrition. The three patients in group 1 responded well to treatment and healed without further complications. All were discharged home after 7 to 14 days. Patient 2 had his foreign body identified and removed. The two patients in group 2 had a nasogastric tube nasogastric tube n. A tube that is passed through the nasal passages and into the stomach. Nasogastric tube A tube placed through the nose into the stomach. Mentioned in: Life Support inserted for enteral feeding while they were still under anesthesia for esophagoscopy. Both did well and were discharged within 10 days. Patient 1 had her foreign body identified and removed. The three patients in group 3 had more difficult hospitalizations, which ranged from 23 to 28 days. Patients 3 and 8 had their foreign body identified and removed. Patient 3 required a bilateral chest drain. In patient 4, a 36-year-old woman, the iatrogenic esophageal perforation was not diagnosed until almost 24 hours following esophagoscopy. Upon diagnosis, medical treatment was immediately initiated. She had a persistent low-grade fever In medicine, low-grade fever is a continuous or fluctuating low fever, typically defined as never exceeding 38.5 degrees Celsius (about 101 degrees Fahrenheit). It is a non-specific finding, but occurs in many diseases, ranging from infectious (viral infections or infective and leukocytosis. Serial computed tomography Computed tomography (CT scan) X rays are aimed at slices of the body (by rotating equipment) and results are assembled with a computer to give a three-dimensional picture of a structure. (CT) images of her neck and thorax thorax, body division found in certain animals. In humans and other mammals it lies between the neck and abdomen and is also called the chest. The skeletal frame of the thorax is formed by the sternum (breastbone) and ribs in front and the dorsal vertebrae in back. on days 3 and 4 post-esophagoscopy showed a retropharyngeal abscess that had extended to the superior mediastinum The superior mediastinum is that portion of the interpleural space which lies between the manubrium sterni in front, and the upper thoracic vertebrae behind. Boundaries It is bounded:
tho·ra·cot·o·my n. Incision into the chest wall. Also called pleurotomy. to drain the collections, and she was admitted to the intensive care unit for a brief period of postoperative mechanical ventilation mechanical ventilation n. A mode of assisted or controlled ventilation using mechanical devices that cycle automatically to generate airway pressure. and close monitoring. She was discharged on hospital day 26. Our experience suggests that patients such as those in group 3 are more likely to require surgical intervention, prolonged nutritional support nutritional support, n the supply of foods and liquids necessary to advance healing and support health. , and admission to the intensive care unit. Neck abscess. Four patients (patients 9, 10, 11, and 12) presented with a neck abscess, and they experienced a more difficult course than did most of those who had a perforation only. Patient 11 had her foreign body identified and removed. Patients 9, 10, and 12 underwent neck exploration and surgical drainage within 24 hours of their diagnosis by CT or ultrasonography ultrasonography /ul·tra·so·nog·ra·phy/ (-so-nog´rah-fe) the imaging of deep structures of the body by recording the echoes of pulses of ultrasonic waves directed into the tissues and reflected by tissue planes where there is a change in . Patient 11 refused surgery and was treated conservatively. All recovered. Patient 12, a 72-year-old man, underwent a tracheostomy for airway protection and an intraoral incision for drainage of the abscess, which had extended to the level of the uvula uvula: see palate. . He was discharged on day 59; his long hospitalization was necessary because of his underlying diabetes mellitus diabetes mellitus Disorder of insufficient production of or reduced sensitivity to insulin. Insulin, synthesized in the islets of Langerhans (see Langerhans, islets of), is necessary to metabolize glucose. In diabetes, blood sugar levels increase (hyperglycemia). , a postoperative chest infection, and the time required to wean wean (wen) to discontinue breast feeding and substitute other feeding habits. wean v. 1. To deprive permanently of breast milk and begin to nourish with other food. 2. him off his tracheostomy tube Tracheostomy tube A tube which is inserted into an incision in the trachea (tracheostomy) to relieve upper airway obstruction. Mentioned in: Anaphylaxis tracheostomy tube . Discussion Potentially fatal complications such as esophageal esophageal /esoph·a·ge·al/ (e-sof?ah-je´al) of or pertaining to the esophagus. esophageal of or pertaining to the esophagus. esophageal achalasia see megaesophagus. and pharyngeal pharyngeal /pha·ryn·ge·al/ (fah-rin´je-al) pertaining to the pharynx. pha·ryn·geal or pha·ryn·gal adj. Of, relating to, located in, or coming from the pharynx. perforation and deep neck abscess can develop well within 24 hours of foreign-body impaction. Pain that persists or worsens with time should be regarded as an early symptom of a serious complication. Moreover, fever and leukocytosis should not occur in uncomplicated cases of ingested foreign bodies. Pain, fever, and/or leukocytosis were present in all 12 of our patients. Thus, any patient who has ingested a foreign body and who manifests any of these features should be assumed to have a serious complication until proven otherwise. Fish bones are the most common ingested foreign body in Hong Kong, accounting for approximately 80% of all cases. (1) In our series, 6 of the 12 patients had ingested a fish bone; the others had ingested either a chicken, pork, beef, or duck bone. It seems logical that bulky bones would be more dangerous than fish bones. Esophagoscopy. Among the entire population of 5,848 patients, esophagoscopy was performed in 519 (8.9%). We consider any suspicion of a perforation or neck abscess related to an ingested foreign body a strong indication for esophagoscopy because any treatment--conservative or surgical--will not be successful if a foreign body is left impacted. Esophagoscopy can either identify the presence of an impacted foreign body or rule out its presence; in the latter circumstance, we can assume that the foreign body became dislodged on its own. We prefer rigid esophagoscopy performed under general anesthesia Anesthesia, General Definition General anesthesia is the induction of a state of unconsciousness with the absence of pain sensation over the entire body, through the administration of anesthetic drugs. to flexible esophagoscopy performed under topical anesthesia Topical Anesthesia Definition Topical anesthesia is a condition of temporary numbness caused by applying a substance directly to a surface of the body. Loss of feeling occurs in the specific areas touched by the anesthetic substance. with sedation Sedation Definition Sedation is the act of calming by administration of a sedative. A sedative is a medication that commonly induces the nervous system to calm. Purpose The process of sedation has two primary intentions. , for two reasons. First, rigid esophagoscopy provides a better view of the cricopharyngeus and cervical esophagus. Second, flexible esophagoscopy is more likely to cause further contamination through the perforation because air insufflation insufflation /in·suf·fla·tion/ (-sah-fla´shun) 1. the act of blowing a powder, vapor, or gas into a body cavity. 2. finely powdered or liquid drugs carried into the respiratory passages by such devices as aerosols. is necessary to obtain a good view. Before esophagoscopy is initiated for any patient with an esophageal or pharyngeal perforation, the anesthetist anesthetist /anes·the·tist/ (ah-nes´the-tist) a nurse or technician trained to administer anesthetics. a·nes·the·tist n. A person trained to administer anesthetics. should be warned so that IV induction rather than gas induction can be administered. Esophageal perforation. Whether they are caused by a foreign body or iatrogenically, esophageal perforations generally occur at the narrowest part of the esophagus, at or close to the cricopharyngeus. The risk of iatrogenic esophageal perforation has been reported to range from 0.2 to 1.2% with rigid esophagoscopy and 0.02 to 0.05% with flexible esophagoscopy. (5,9-13) In our series, 5 of the 441 rigid esophagoscopies (1.13%) resulted in an iatrogenic perforation; there were no perforations among the 78 patients who underwent flexible esophagoscopy. The incidence of esophageal perforation or neck abscess following foreign-body ingestion in our series (0.21%) is comparable to the 0.96% reported by Nandi and Ong in their series of 2,394 patients. (2) Mortality secondary to esophageal perforation is high; reports of mortality have ranged from 9 to 32%. (5,14-16) After Barret (17) described suture suture /su·ture/ (soo´cher) 1. sutura. 2. a stitch or series of stitches made to secure apposition of the edges of a surgical or traumatic wound. 3. to apply such stitches. 4. repair of a spontaneous esophageal rupture in 1947, most authors recommended early surgical closure of a proven perforation and drainage of the contaminated area as the mainstays of management. (3-5) Conservative treatment was not yet feasible. In fact, Derbes and Mitchell reported in 1956 that conservative treatment of 171 such patients resulted in 100% mortality. (18) But over the past 25 years, several authors have reported good results with the use of potent broad-spectrum antibiotics and enteral or parenteral parenteral /pa·ren·ter·al/ (pah-ren´ter-al) not through the alimentary canal, but rather by injection through some other route, as subcutaneous, intramuscular, etc. par·en·ter·al adj. 1. nutritional support. (6-8) For example, Cameron et al (7) and Shaffer et al (8) reported no mortality in selected groups of patients who were treated conservatively. Although the number of patients in most of these series was small, we can still conclude that conservative treatment has a definite role for carefully chosen patients. We believe that the management of a patient with an esophageal perforation related to an ingested foreign body should be individualized in·di·vid·u·al·ize tr.v. in·di·vid·u·al·ized, in·di·vid·u·al·iz·ing, in·di·vid·u·al·iz·es 1. To give individuality to. 2. To consider or treat individually; particularize. 3. . But regardless of the cause of the perforation, treatment results are closely related to the degree of contamination. Seven of the eight esophageal perforations in our series were located in the cervical esophagus. Symptoms of a perforation at this site usually manifest early, and the perforation itself can be easily located. Therefore, the diagnosis of a perforation should be made before significant soiling occurs. Early diagnosis confers favorable odds for conservative management. However, we must again emphasize that a conservative approach can succeed only if there is no foreign body left impacted at the site of the perforation. Prohibiting oral food and liquids for 1 to 2 weeks is important in order to minimize contamination through a perforation. In these cases, adequate nutritional support is most logically and conveniently delivered by nasogastric tube. The only patient in our series who was not fed by nasogastric tube was patient 3, whose iatrogenic perforation was located in her lower thorax. We were concerned that if we inserted a nasogastric tube past the perforation, it might traverse the breach in her esophagus. Therefore, this patient received total parenteral nutrition. The presence of a nasogastric tube can also cause gastroesophageal reflux gastroesophageal reflux n. A backflow of the contents of the stomach into the esophagus, caused by relaxation of the lower esophageal sphincter. Also called esophageal reflux, gastric reflux. and adversely affect the healing of a perforation. Resolution of pain, fever, and leukoeytosis normally suggests that a perforation is healing. Healing should be confirmed by a contrast swallow examination before a patient resumes oral feeding. If a patient's clinical progress is satisfactory, a swallow examination should be performed between hospital days 5 and 7. Keep in mind, however, that contrast swallow examinations have been reported to have missed small leaks in as many as 10% of patients. (14) If there is any evidence that casts doubt that healing has occurred (e.g., persistent leukocytosis), it may be worthwhile to delay oral feeding until healing is beyond doubt. The microflora microflora /mi·cro·flo·ra/ (-flor´ah) the microscopic vegetable organisms of a special region. Microflora The bacterial population in the intestine. of the esophagus is made up of gram-positive cocci cocci /coc·ci/ (kok´si) plural of coccus. cocci [L.] plural of coccus. , gram-negative bacilli bacilli /ba·cil·li/ (bah-sil´i) plural of bacillus. bacilli see bacillus. , and anaerobes. (19) Broad-spectrum antibiotics should be used to cover all these potential pathogens. Our usual choice is a second-generation cephalosporin cephalosporin (sĕf'əlōspôr`ĭn), any of a group of more than 20 antibiotics derived from species of fungi of the genus Cephalosporium and closely related chemically to penicillin. Cephalosporins, e.g. (e.g., cefuroxime) or a betalactamase --resistant penicillin (e.g., ampicillin/sulbactam) plus metronidazole metronidazole /met·ro·ni·da·zole/ (-ni´dah-zol) an antiprotozoal and antibacterial effective against obligate anaerobes; used as the base or the hydrochloride salt. It is also used as a topical treatment for rosacea. . Modification of the regimen depends on the clinical response and the results of microbiologic cultures and sensitivity tests. It is accepted that a cervical perforation carries a better prognosis than a thoracoabdominal perforation. (3,14,17) Moreover, an early diagnosis, especially within 24 hours, has been associated with a better prognosis in most series. (3,13.20-22) Iatrogenic perforation and perforation caused by a foreign body carry a better prognosis than do spontaneous and traumatic perforations. (14,23) The success of conservative management in our series can be attributed to early diagnosis and limited contamination through the perforation. In our experience, a failure of conservative treatment becomes evident early rather than late, and close monitoring is essential. Neck abscess. When clinical progress during conservative treatment is unsatisfactory, the possibility of a neck abscess should be investigated by computed tomography. If an abscess is found, surgical intervention should take place without delay. In our series, the four cases of retropharyngeal abscess secondary to an ingested foreign body tended to occur late. Three of these patients presented 4 days after foreign-body ingestion while the other presented 19 days after the event. In contrast, the three patients with foreign-body-induced esophageal perforation (patients 2, 5, and 6) all presented within 24 hours. In patients 9, 10, 11, and 12, it is likely that the ingested foreign body caused a small perforation, and leakage through the perforation resulted in the development of an abscess over a period of days or weeks. Only one of these four patients (patient 11) had the foreign body retrieved; it is probable that the other three foreign bodies had extruded from the friable friable /fri·a·ble/ (fri´ah-b'l) easily pulverized or crumbled. fri·a·ble adj. 1. Readily crumbled; brittle. 2. Relating to a dry, brittle growth of bacteria. inflamed tissue and become dislodged. Rigid esophagoscopy is essential for evaluating a neck abscess that is caused by a foreign body. Otherwise, management (surgical drainage, IV antibiotics, and airway protection) in these cases is the same as it is for neck abscesses secondary to other causes. (24,25) The antibiotic regimen for neck abscesses is similar to that used for esophageal perforations; the pathogens in neck abscesses are usually polymicrobial and contain anaerobes. (25)
Table 1. Summary of eight cases of esophageal perforation
Foreign Time to
Patient Sex/age body (FB) presentation
1 * F/74 Duck bone 4 days
2 ([dagger]) M/8 Chicken bone <24 hr
3 ([double dagger]) F/59 Fish bone <24 hr
4 ([double dagger]) F/36 Pork bone 2 days
5 ([dagger]) F/62 Fish bone <24 hr
6 ([dagger]) M/16 Beef bone <24 hr
7 * M/42 Pork bone <24 hr
8 ([double dagger]) F/21 Fish bone <24 hr
Patient Site of perforation Time of diagnosis
1 * Cervical esophagus During esophagoscopy
2 ([dagger]) Cervical esophagus <24 hr of FB ingestion
3 ([double dagger]) Lower thorax <48 hr following esoph-
agoscopy
4 ([double dagger]) Cervical esophagus -24 hr following eso-
phagoscopy
5 ([dagger]) Cervical esophagus <24 hr of FB ingestion
6 ([dagger]) Cervical esophagus <24 hr of FB ingestion
7 * Cervical esophagus During esophagoscopy
8 ([double dagger]) Cervical esophagus <24 hr following esoph-
agoscopy
Patient Clinical features Diagnosis confirmed by
1 * Postesophagoscopy Perforation noticed du-
fever, leukocytosis ring esophagoscopy
2 ([dagger]) Refusal to eat, fe- FB shadow, retropharyn-
ver, leukocytosis geal free gas on later-
al neck x-ray
3 ([double dagger]) Postesophagoscopy Esophageal-pleural fis-
chest pain, fever, tula on contrast
leukocytosis swallow
4 ([double dagger]) Postesophagoscopy Prevertebral soft-tis-
fever, leukocytosis sue swelling on lateral
neck x-ray; soft-tissue
swelling and retropha-
ryngeal free gas on CT
5 ([dagger]) Sore throat, fever, Retropharyngeal free gas
leukocytosis on lateral neck x-ray
6 ([dagger]) Upper chest pain, Retropharyngeal free gas
neck crepitus on lateral neck x-ray;
pneumomediastinum on
chest x-ray
7 * Postesophagoscopy Perforation noticed
sore throat, fever, during esophagoscopy
leukocytosis
8 ([double dagger]) Postesophagoscopy Leakage from cervical
fever, leukocytosis, esophagus on contrast
neck crepitus swallow exam
Patient Treatment Outcome
1 * IV antibiotics, Discharged home on
nasogastric tube day 9
feeding for 7 days
2 ([dagger]) IV antibiotics, Discharged home on
nasogastric tube day 12
feeding for 10 days
3 ([double dagger]) Bilateral chest Discharged home on
drain, IV antibio- day 28
tics, total parente-
ral nutrition for
21 days
4 ([double dagger]) Neck exploration, Admitted to intensive
right thoracotomy, care unit for 6 days;
left chest drain, IV discharged home on
antibiotics, naso- day 26
gastric tube feeding
for 13 days
5 ([dagger]) IV antibiotics, Discharged home on
nasogastric tube day 14
feeding for 11 days
6 ([dagger]) IV antibiotics, Discharged home on
nasogastric tube day 7
feeding for 5 days
7 * IV antibiotics, Discharged home on
nasogastric tube day 7
feeding for 6 days
8 ([double dagger]) IV antibiotics, Discharged home on
nasogastric tube day 23
feeding for 21 days
* Iatrogenic perforation diagnosed during esophagoscopy; ([dagger])
esophageal perforation diagnosed at presentation; ([double dagger])
iatrogenic perforation diagnosed after esophagoscopy.
Table 2. Summary of five cases of neck abscess
Foreign Time to
Patient Sex/age body (FB) presentation
4 * F/36 Pork bone 2 days
9 M/30 Fish bone 19 days
10 F/25 Fish bone 4 days
11 F/79 Pork bone 4 days
12 M/72 Fish bone 4 days
Patient Cause of abscess Clinical features
4 * latrogenic esopha- Fever, retrosternal
geal perforation pain, shortness of
breath, leukocytosis
9 FB Fever, sore throat,
odynophagia,
leukocytosis
10 FB Fever, sore throat,
leukocytosis
11 FB Fever, sore throat,
leukocytosis
12 FB Fever, odynophagia,
leukocytosis
Patient Radiologic findings Microbiology
4 * Soft-tissue swelling Group D streptococci
and retropharyngeal and Escherichia coli on
free gas on CT; pleural swab
bilateral pleural
effusions on chest
x-ray
9 Retropharyngeal No growth in pus from
swelling on lateral abscess
neck x-ray
10 Left parapharyngeal Hemolytic streptococci
and retropharyngeal and Streptococcus mill-
collection on neck eri in pus from absces
ultrasonography
11 Prevertebral air- No specimen obtained
fluid level at C5-C6
on lateral neck
x-ray
12 Retropharyngeal Klebsiella, Pseudomonas,
swelling on lateral and Peptostreptococus
pharyngeal abscess species in pus from
on CT abscess
Patient Treatment Outcome
4 * Neck exploration, Admitted to intensive
right thoracotomy, care unit for 6 days;
left chest drain, IV discharged home on day
antibiotics, naso- 26
gastric tube feeding
for 13 days
9 Rigid esophagoscopy, Discharged home on
internal drainage of day 8
retropharyngeal
abscess, IV antibio-
tics, nasogastric
tube feeding
10 Neck exploration, IV Discharged home on
antibiotics, naso- day 31
gastric tube feeding
11 IV antibiotics, na- Discharged home on
sogastric tube day 11
feeding (patient
refused surgery)
12 Neck exploration, Admitted to the inten-
intraoral drainage, sive care unit for 3
tracheostomy, IV days; discharged home
antibiotics, naso- on day 59 (the long
gastric tube feeding hospitalization was the
result of underlying
diabetes, concomitant
chest infection, and
the time required to
wean the patient off
his tracheostomy tube)
* Same patient as patient 4 in table 1.
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Presentation and management-of neck abscess: A retrospective analysis. Laryngoscope 1988;98(Pt 1): 877-80. (25.) Har-El G, Aroesty JH. Shaha A, Lucente FE. Changing trends in deep neck abscess. A retrospective study retrospective study, a study in which a search is made for a relationship between one phenomenon or condition and another that occurred in the past (e.g. of 110 patients. Oral Surg Oral Med Oral Pathol 1994;77:446-50. From the Division of Otorhinolaryngology otorhinolaryngology /oto·rhi·no·lar·yn·gol·o·gy/ (-ri?no-lar?ing-gol´ah-je) the branch of medicine dealing with the ear, nose, and throat. o·to·rhi·no·lar·yn·gol·o·gy n. , Department of Surgery, Chinese University of Hong Kong The motto of the university is "博文約禮" in Chinese, meaning "to broaden one's intellectual horizon and keep within the bounds of propriety". , Prince of Wales Hospital, Shatin, N.T., Hong Kong. Reprint requests: Prof. C. Andrew van Hasselt, Division of Otorhinolaryngology, Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong, S.A.R. Phone: 852-2632 2628; fax: 852 2646 6312; e-mail: andrewvan@surgery.cuhk.edu.hk |
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