Iatrogenic hypopharyngeal perforation – a retrospective case series

Introduction:

The iatrogenic hypopharyngeal perforation is a rare but in case of delayed diagnosis potentially lethal complication. It can be caused by a variety of medical interventions and requires high demands on treating ENT surgeons. Given the small number of cases there is no established treatment concept. In this case series we evaluated the clinical course and the surgical care and presented the long-term outcome.

Patients and methods:

By combined search with the OPS codes 5 – 293 and 5 – 294, as well as with the diagnosis code J39.2 in our SAP database, we generated a list of patients that were treated in the ENT department of the Charité – Universitätsmedizin Berlin due to an iatrogenic hypopharyngeal perforation. We included 7 patients that were treated surgically in the years 2006 – 2017.

Results:

In 4 cases a neurosurgical operation on the anterior cervical spine, in 2 cases a TEE and in one case an ERCP caused the perforation.

In all cases a CT scan of the neck and chest was performed detecting a cervical emphysema. Following panendoscopy the perforation was closed using a lateral cervicotomy with a two-layer perforation closure. In 3 cases extended coverage was performed with local muscle flaps.

Conclusion:

In the case of postinterventional or postoperative odynodysphagia, oral bleeding or emphysema, a CT scan should be performed. In the case of perforation, lateral cervicotomy access is a safe method for perforation closure and drainage. Advanced local inflammations and the size of the injuries make a primarily endoluminal closure difficult. A cranially pediculated SCM flap appears suitable for hypopharyngeal perforations.

Publication History

Publication Date:
23 April 2019 (online)