Field Samantha M, Manjaly Joseph G, Ramdoo S Krishan, Jones Huw A S, Tatla Taran S
Department of Otolaryngology-Head and Neck Surgery, Northwick Park Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK.
Case Rep Otolaryngol. 2014;2014:382495. doi: 10.1155/2014/382495. Epub 2014 Nov 26.
Introduction. Pharyngoesophageal perforation secondary to barotrauma is a rare phenomenon that can have serious complications if identified late. It is challenging to detect due to nonspecific symptoms. We present a case in which detection proved difficult leading to delayed diagnosis. Case Report. A 27-year-old mechanic presented with haemoptysis, dysphonia, and odynophagia after a car tyre exploded in his face. Flexible nasoendoscopy (FNE) revealed blood in the pharynx, thought to represent mucosal haemorrhage. Initial treatment consisted of IV dexamethasone and antibiotics. After 3 days, odynophagia persisted prompting a CT scan. This revealed a defect in the posterior hypopharynx and surgical emphysema in the deep neck tissues. Contrast swallow confirmed posterior hypopharyngeal leak. NG feeding was commenced until repeated contrast swallow confirmed resolution of the defect. Discussion. Prompt nonsurgical management of pharyngoesophageal perforation has good outcomes but untreated perforation can have serious complications. FNE should be performed routinely, but only a contrast swallow can diagnose a functional perforation. Clinicians should have a high index of clinical suspicion when patients present with barotrauma and odynophagia. Patients should be kept nil by mouth until perforation has been excluded. Conclusion. When faced with cases of facial barotrauma, clinicians should have a low threshold for further imaging to exclude pharyngoesophageal perforation.
引言。气压伤继发的咽食管穿孔是一种罕见现象，如果诊断延迟可能会引发严重并发症。由于症状不具特异性，其检测具有挑战性。我们报告一例检测困难导致诊断延迟的病例。病例报告。一名27岁的机械师在汽车轮胎在其面部爆炸后出现咯血、声音嘶哑和吞咽疼痛。可弯曲鼻内镜检查（FNE）显示咽部有血，认为是黏膜出血。初始治疗包括静脉注射地塞米松和抗生素。3天后，吞咽疼痛持续，于是进行了CT扫描。结果显示下咽后部有缺损，颈部深层组织有手术性气肿。吞咽造影证实下咽后部渗漏。开始鼻饲，直到重复吞咽造影证实缺损已愈合。讨论。咽食管穿孔的及时非手术治疗效果良好，但未经治疗的穿孔可能会引发严重并发症。应常规进行FNE，但只有吞咽造影才能诊断功能性穿孔。当患者出现气压伤和吞咽疼痛时，临床医生应保持高度的临床怀疑。在排除穿孔之前，患者应禁食。结论。面对面部气压伤病例时，临床医生应降低进一步影像学检查的阈值以排除咽食管穿孔。
