Kobayashi Makoto, Saito Junnosuke, Fujino Hiroki, Sakurai Kyohei, Ehama Yoshimatsu
Director of Surgery and Intensive Care Center, Hakodate Goryoukaku Hospital, Hakodate City, Hokkaido, Japan.
Division of Emergency Medicine, Hakodate Goryoukaku Hospital, Hakodate City, Hokkaido, Japan.
Trauma Case Rep. 2024 Nov 23;54:101120. doi: 10.1016/j.tcr.2024.101120. eCollection 2024 Dec.
Pharyngeal perforation has been documented as a consequence of substantial external force applied to the neck. Such trauma is frequently accompanied by additional organ injury and cervical fracture. In this report, we present an exceptionally rare instance in which minor blunt trauma to the neck resulted in pharyngeal injury without concomitant damage to other organs.
An 18-year-old woman sustained a contusion of the neck due to blunt trauma to the left submandibular region from her bicycle handlebar grip following a collision with a motor vehicle. The patient exhibited a minor contusion of the neck, devoid of active bleeding or hematoma. Furthermore, she did not express any concerns regarding the condition of her neck or throat. A medical examination revealed the absence of abnormal breath sounds in the neck and the absence of any deformity or deviation of the airway. Despite the absence of a foreign body, computed tomography demonstrated the presence of free air extending through the interstitial space between the sternocleidomastoid muscle and larynx, reaching the posterior pharyngeal wall. While the wound was being cleansed with saline solution, the patient reported a sensation of water entering the mouth, which led to the confirmation of a perforation injury to the pharynx. No evidence of leakage was observed during the drinking tests, and the fistula was determined to be unidirectional. The patient was admitted to the hospital for follow-up and discharged on the third day without any additional complications. The outpatient examination conducted on the sixth day following the injury revealed no abnormalities in the physical findings.
Perforating pharyngeal injuries resulting from minor blunt trauma are exceedingly uncommon. In the present case, the water injection test and drinking test were instrumental in both confirming the diagnosis and determining the appropriate treatment plan.
咽穿孔已被记录为颈部受到巨大外力作用的后果。此类创伤常伴有其他器官损伤和颈椎骨折。在本报告中，我们呈现了一个极为罕见的案例，即颈部轻微钝性创伤导致咽部损伤，而其他器官未受损伤。
一名18岁女性在与机动车碰撞后，因自行车车把撞击左下颌下区域而颈部挫伤。患者颈部有轻微挫伤，无活动性出血或血肿。此外，她对自己的颈部或喉咙状况未表示任何担忧。体格检查显示颈部无异常呼吸音，气道无任何畸形或偏移。尽管没有异物，但计算机断层扫描显示有游离气体通过胸锁乳突肌和喉部之间的间隙延伸至咽后壁。在用生理盐水清洗伤口时，患者报告有水流入口中的感觉，这证实了咽部穿孔损伤。饮水试验期间未观察到渗漏迹象，瘘管被确定为单向。患者入院接受随访，第三天出院，无任何其他并发症。受伤后第六天的门诊检查显示体格检查无异常。
轻微钝性创伤导致的咽部穿孔伤极为罕见。在本病例中，注水试验和饮水试验有助于确诊并确定合适的治疗方案。
