Lau Wing-Him, Chang Wei-Chieh, Tsuei Yuang-Seng, Cheng Wen-Yu, Chao Shao-Ching, Shen Chiung-Chyi
Department of Surgery, Cheng Ching General Hospital, Taichung, Taiwan.
Surg Neurol Int. 2010 Sep 16;1:56. doi: 10.4103/2152-7806.69383.
Esophageal dilatation is the most widely used treatment option for the management of esophageal strictures. Complications include bleeding, brain abscess, esophageal perforation and bacteremia. Nasopharyngeal gangrenous abscess after the esophageal dilatation is very rare. Endonasal endoscopic surgery was performed to treat the lesion and a successful result was obtained.
A 59-year-old woman with a previous history of dilatation for esophageal stricture was admitted with a low-grade fever, headache, neck pain and cranial nerve abnormalities including sixth nerve palsy. Imaging studies aroused suspicion of necrotic retropharyngeal tumor with clivus, condylar process and cavernous sinus invasion. Biopsy with a pharyngosope was performed by an ENT doctor. The pathology showed acute necrotic inflammation, tissue granulation and bacteria colonies. Navigation with endonasal endoscopic surgery was chosen to treat the skull base and nasopharyngeal abscess. Bacterial culture showed Escherichia coli. Symptoms improved after the operation and treatment with antibiotics.
A nasopharyngeal gangrenous abscess with extension to the skull base in the case of esophageal reconstruction after esophageal dilatation is extremely rare. Physicians dealing with esophageal stricture should keep in mind that a nasopharyngeal abscess is a potential complication of esophageal dilatation.
食管扩张术是治疗食管狭窄最常用的方法。并发症包括出血、脑脓肿、食管穿孔和菌血症。食管扩张术后发生鼻咽部坏疽性脓肿极为罕见。采用鼻内镜手术治疗该病变并取得成功。
一名59岁女性，既往有食管狭窄扩张病史，因低热、头痛、颈部疼痛及包括第六神经麻痹在内的颅神经异常入院。影像学检查怀疑为坏死性咽后肿瘤侵犯斜坡、髁突和海绵窦。耳鼻喉科医生用咽镜进行活检。病理显示急性坏死性炎症、组织肉芽和菌落。选择鼻内镜手术导航治疗颅底和鼻咽部脓肿。细菌培养显示为大肠杆菌。术后经抗生素治疗症状改善。
食管扩张术后食管重建时出现累及颅底的鼻咽部坏疽性脓肿极为罕见。处理食管狭窄的医生应牢记，鼻咽部脓肿是食管扩张术的潜在并发症。
