Effective management of a retropharyngeal abscess using endoscopic complete-layer resection and drainage

Retropharyngeal abscess, a rare complication of foreign body ingestion that is usually associated with trauma to the retropharyngeal wall [1] [2], is also a life-threatening medical and surgical emergency, which usually requires incision and drainage [3]. Foreign bodies such as fish bones are the most common traumatic cause of retropharyngeal abscess [4]. We present a case to illustrate endoscopic complete-layer resection with drainage as a safe and effective method of treating retropharyngeal abscesses.

A 72-year-old man presented with fever and pain on swallowing for 2 days; the patient had swallowed a fish bone 20 days earlier. Computed tomography showed a retropharyngeal abscess ([Fig. 1]). Gastroscopy revealed swollen left retropharyngeal tissue and a white pus point ([Fig. 2]a). Advancing the gastroscope through the left pharyngeal and piriform fossa was difficult ([Video 1]). A large volume of pus was drained following the dissection of the pus point with a dual knife. Following the near-complete outflow of pus, an insulation-tipped knife was used to dissect the entire thickness of the swollen tissue, expose the abscess cavity, and ensure complete drainage. The abscess cavity contained minimal pus ([Fig. 2]b). A nasogastric tube was placed into the stomach to provide enteral nutrition.

Fig. 1 Computed tomography image, showing left retropharyngeal abscess with suspected separated diaphragm.

Fig. 2 Endoscopic view. a Pus point on the retropharyngeal abscess. b Exposed abscess cavity after endoscopic complete-layer resection.

Effective management of a retropharyngeal abscess by endoscopic complete-layer resection and drainage.Video 1

Computed tomography on postintervention Day 2 revealed an empty abscess cavity ([Fig. 3]a). Computed tomography 2 weeks after intervention revealed normal left retropharyngeal tissue ([Fig. 3]b).

Fig. 3 Computed tomography. a Image 2 days after intervention, showing completely drained left retropharyngeal abscess. b Image 2 weeks after intervention, showing normal retropharyngeal tissue.

Endoscopy_UCTN_Code_TTT_1AS_2AG

Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Costa L, Larangeiro J, Pinto Moura C. et al. Foreign body ingestion: rare cause of cervical abscess. Acta Med Port 2014; 27: 743-748
• 2 Vourexakis Z, Konu P. Retropharyngeal abscess complicating ‘innocent’ foreign body ingestion. BMJ Case Rep 2014;
• 3 Keïta A, Diallo I, Fofana M. et al. Retropharyngeal abscess: case study of 5 cases and literature review. Pan Afr Med J 2020; 36: 360
• 4 Harkani A, Hassani R, Ziad T. et al. Retropharyngeal abscess in adults: five case reports and review of the literature. Sci World J 2011; 11: 1623-1629

Publication History

Article published online:
20 November 2023