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Pharyngeal perforation following laryngoscopy in a patient with dysphagia secondary to diffuse idiopathic skeletal hyperostosis: A case report

RATIONALE: Dysphagia is a common presenting symptom in elderly people. Nevertheless, dysphagia resulting from diffuse idiopathic skeletal hyperostosis (DISH) of patients’ cervical spine may be due to several factors. Despite computed tomography scan showing the size and shape of osteophytes, endosco...

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Autores principales: Gao, Hongxiang, Li, Xueju, Wang, Cunping
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402913/
https://www.ncbi.nlm.nih.gov/pubmed/32756197
http://dx.doi.org/10.1097/MD.0000000000021526
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author Gao, Hongxiang
Li, Xueju
Wang, Cunping
author_facet Gao, Hongxiang
Li, Xueju
Wang, Cunping
author_sort Gao, Hongxiang
collection PubMed
description RATIONALE: Dysphagia is a common presenting symptom in elderly people. Nevertheless, dysphagia resulting from diffuse idiopathic skeletal hyperostosis (DISH) of patients’ cervical spine may be due to several factors. Despite computed tomography scan showing the size and shape of osteophytes, endoscopy may be necessary to exclude other intrinsic causes of dysphagia. Due to the anatomic variation of the pharynx secondary to DISH, patients undergoing endoscopy are at risk of perforation. Once perforation occurs, inappropriate treatments may finally lead to an irretrievable outcome. PATIENT CONCERNS: A 58-year-old male patient with a 20-day history of dysphagia initially visited an ear-nose-throat (ENT) doctor. He had no neck pain and no other history of cervical disease. DIAGNOSIS: This patient with dysphagia due to DISH of the cervical spine underwent laryngoscopy to exclude other causes. Pharyngeal perforation resulted as a complication of the procedure. INTERVENTIONS: The patient underwent laryngoscopy and biopsy by an ENT doctor to exclude intrinsic causes. After the procedure, a perforation was formed on the posterior wall of the pharynx. Conservative management, that is, 1 week of nothing per oral, and 1 month of antibiotics, was adopted. On the 30th day after the examination, the patient was voluntarily discharged from the hospital and recommended to take antibiotics orally. OUTCOMES: On the 56th day, the patient experienced fever and neck pain. Magnetic resonance imaging showed that the cervical vertebral bodies and spinal cord were infected. On the midday of the 60th day, the patient had a failed resuscitation and died. LESSONS: DISH involving the cervical spine is a complicated cause of dysphagia. Due to the anatomic variation of the pharynx secondary to DISH, patients undergoing endoscopy are at risk of perforation. If other intrinsic causes of dysphagia have to be excluded with the aid of endoscopy, plain films and computed tomography images should be read carefully first. To minimize the risk of perforation, it is necessary to perform endoscopy extremely carefully, especially biopsy. Once perforation occurs, operative treatment may be more appropriate and effective.
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spelling pubmed-74029132020-08-14 Pharyngeal perforation following laryngoscopy in a patient with dysphagia secondary to diffuse idiopathic skeletal hyperostosis: A case report Gao, Hongxiang Li, Xueju Wang, Cunping Medicine (Baltimore) 7100 RATIONALE: Dysphagia is a common presenting symptom in elderly people. Nevertheless, dysphagia resulting from diffuse idiopathic skeletal hyperostosis (DISH) of patients’ cervical spine may be due to several factors. Despite computed tomography scan showing the size and shape of osteophytes, endoscopy may be necessary to exclude other intrinsic causes of dysphagia. Due to the anatomic variation of the pharynx secondary to DISH, patients undergoing endoscopy are at risk of perforation. Once perforation occurs, inappropriate treatments may finally lead to an irretrievable outcome. PATIENT CONCERNS: A 58-year-old male patient with a 20-day history of dysphagia initially visited an ear-nose-throat (ENT) doctor. He had no neck pain and no other history of cervical disease. DIAGNOSIS: This patient with dysphagia due to DISH of the cervical spine underwent laryngoscopy to exclude other causes. Pharyngeal perforation resulted as a complication of the procedure. INTERVENTIONS: The patient underwent laryngoscopy and biopsy by an ENT doctor to exclude intrinsic causes. After the procedure, a perforation was formed on the posterior wall of the pharynx. Conservative management, that is, 1 week of nothing per oral, and 1 month of antibiotics, was adopted. On the 30th day after the examination, the patient was voluntarily discharged from the hospital and recommended to take antibiotics orally. OUTCOMES: On the 56th day, the patient experienced fever and neck pain. Magnetic resonance imaging showed that the cervical vertebral bodies and spinal cord were infected. On the midday of the 60th day, the patient had a failed resuscitation and died. LESSONS: DISH involving the cervical spine is a complicated cause of dysphagia. Due to the anatomic variation of the pharynx secondary to DISH, patients undergoing endoscopy are at risk of perforation. If other intrinsic causes of dysphagia have to be excluded with the aid of endoscopy, plain films and computed tomography images should be read carefully first. To minimize the risk of perforation, it is necessary to perform endoscopy extremely carefully, especially biopsy. Once perforation occurs, operative treatment may be more appropriate and effective. Wolters Kluwer Health 2020-07-31 /pmc/articles/PMC7402913/ /pubmed/32756197 http://dx.doi.org/10.1097/MD.0000000000021526 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 7100
Gao, Hongxiang
Li, Xueju
Wang, Cunping
Pharyngeal perforation following laryngoscopy in a patient with dysphagia secondary to diffuse idiopathic skeletal hyperostosis: A case report
title Pharyngeal perforation following laryngoscopy in a patient with dysphagia secondary to diffuse idiopathic skeletal hyperostosis: A case report
title_full Pharyngeal perforation following laryngoscopy in a patient with dysphagia secondary to diffuse idiopathic skeletal hyperostosis: A case report
title_fullStr Pharyngeal perforation following laryngoscopy in a patient with dysphagia secondary to diffuse idiopathic skeletal hyperostosis: A case report
title_full_unstemmed Pharyngeal perforation following laryngoscopy in a patient with dysphagia secondary to diffuse idiopathic skeletal hyperostosis: A case report
title_short Pharyngeal perforation following laryngoscopy in a patient with dysphagia secondary to diffuse idiopathic skeletal hyperostosis: A case report
title_sort pharyngeal perforation following laryngoscopy in a patient with dysphagia secondary to diffuse idiopathic skeletal hyperostosis: a case report
topic 7100
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402913/
https://www.ncbi.nlm.nih.gov/pubmed/32756197
http://dx.doi.org/10.1097/MD.0000000000021526
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