Spontaneous perforation of the pharynx: a case report

Pouryahya  P, McR Meyer A, Gan Ch. Spontaneous perforation of the pharynx: A case report. Med Emergency, MJEM 2019; 27

DOI 10.26738/MJEM.2017/mjem27.2019/PP.CRE.010318

Keywords: aero-digestive, aero-digestive tract, Boerhaave’s syndrome, pharynx, pharynx perforation, perforation, spontaneous perforation, spontaneous pharynx perforation

  • Authors’ affiliation
  • Article history/info
  • Conflict of interest statement

Corresponding author: Pourya POURYAHYA, MD

Casey Hospital, Department of Emergency medicine,

62-70 Kangan drive, Berwick, Victoria 3806, Australia

pourya.pouryahya@monashhealth.org

Pouryahya P,  MD1,2, McR Meyer A, MD1, Gan Ch, MD3

1. Casey hospital, Emergency Department, Program of Emergency Medicine, Monash Health, Melbourne, Australia

2. Monash Emergency Research Collaborative, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia

3. Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia

Category: case report

Received: Oct. 25, 2017

Revised: Nov. 29, 2017

Accepted: Jan. 3, 2018

There is no conflict of interest to declare

ABSTRACT

Introduction: Spontaneous perforation of the pharynx is an uncommon differential diagnosis in patients with odynophagia, presenting to Emergency department (ED).

Case presentation: We describe the case of a 42-year-old male, who presented to our ED, with three-day history of ongoing odynophagia despite symptomatic treatment by his general practitioner (GP) with provisional diagnosis of tonsilo-pharyngitis. After consultation with ENT team because of an unclear diagnosis, laryngoscopy under topicalanesthesia in ED was performed and demonstrated a small vocal cord lesion suspicious of nodule or hematoma. Secondary to inconsistent finding with presenting complaint, Computer Tomography (CT) cervical soft tissue, was performed. Findings include an extensive deep soft tissue emphysema outlining the visceral and carotid spaces bilaterally without radiopaque foreign body suggestive of perforation of the upper aero-digestive tract with indeterminate point of perforation. He subsequently was admitted under ENT team and unlike other reported cases in the medical literature, which usually were treated surgically, was managed conservatively with analgesia and parental antibiotics with a good outcome.