A rare lethal complication of larynxopharynx injuries by a foreign body

Abstract

A lethal complication of laryngopharynx injuries by foreign bodies is a rare phenomenon. Among foreign ­bodies are ingested together with food, fishbones are the most common. They can injure the mucous membrane of the larynx and pharynx due to the sharp edges, thereby causing inflammation, resulting in edema occurs, hyperemia and increased pain. Besides, foreign bodies can provoke complications such as bleeding, cervical phlegmon, subcutaneous emphysema, esophageal perforation, sepsis and others, which can lead to the death of patients. Howe­ver, due to timely diagnosis, according to the scientific literature, such cases are extremely rare. Because the visualization of foreign bodies in the area of the larynx is difficult (especially when localized in the pyriform sinuses), laryngoscopy is used for diagnosis. Moreover, in some cases, X-ray examination and computed tomography are indicated. The paper presents a clinical observation of a 57-year-old patient M., whose cause of death was a rare complication of laryngopharynx injuries with a fishbone. When the patient was admitted to the department, the basic clinical diagnosis was established: laryngopharyngeal injury complicated by right parapharyngeal abscess. The patient underwent antibacterial, infusion, anti-inflammatory and antihypertensive therapy. At 20 hours after hospital admission, the patient had an abrupt loss of consciousness and cardiac arrest, then death. Based on the clinical picture, it was concluded that pulmonary thromboembolism was the probable cause of death. The ­autopsy revealed injury of the right external jugular vein, as a result of which develop thrombophlebitis, and then pulmonary artery thromboembolism, which caused the patient's death. No similar clinical descriptions were found in the available scientific literature.

Keywords

foreign body / fish bone / larynxopharynx / trauma / clinical observation

References

[1] Wu E., Huang L., Zhou Y., Zhu X. Migratory fish bone in the thyroid gland: case report and literature review. Case Rep. Med. 2018; 2018: 7345723. DOI: 10.1155/2018/7345723.

[2] Goldman R.D., Gurberg J., Paul Moxham J. A Lodged barramundi fish-bone stabbing the piriform fossa in a child. Pediatr. Emerg. Care. 2018; 34 (12): 243–245. DOI: 10.1097/PEC.0000000000001681.

[3] Bogomilʹskiy M.R., Chistyakova V.R. Detskaya otorinolaringologiya. (Children's otorhinolaryngology.) M.: Meditsina. 2005; 527 р. (In Russ.)

[4] Богомильский М.Р., Чистякова В.Р. Детская оториноларингология. М.: Медицина. 2005; 527 с.

[5] Palʹchun V.T., Magomedov M.M., Luchikhin L.A. Otorinolaringologiya. (Otorhinolaryngology.) M.: GEOTAR-­Media. 2011; 656 p. (In Russ.)

[6] Пальчун В.Т., Магомедов М.М., Лучихин Л.А. Оториноларингология. М.: ГЭОТАР-Медиа. 2011; 656 с.

[7] Temkin Ya.S., Likhachev A.G., Preobrazhenskiy B.S. Bolezni ukha, gorla i nosa. (Ear, nose and throat diseases.) M.: Medgiz. 1947; 374 р. (In Russ.)

[8] Темкин Я.С., Лихачёв А.Г., Преображенский Б.С. Болезни уха, горла и носа. М.: Медгиз. 1947; 374 с.

[9] Cho W.S., Nistor M., Ubayasiri K., Johnston M. ­Unusual “feathery” cause of parapharyngeal abscess in an infant. BMJ Case Rep. 2018; 2018: bcr2017222813. DOI: 10.1136/bcr-2017-222813.

[10] Warner L.L., Ekbom D.C., Warner P.A. The extraordinary case of the hungry woman: large foreign body ingestion with respiratory arrest. A Case Rep. 2017; 8 (6): 147–149. DOI: 10.1213/XAA.0000000000000450.

[11] Bogdanovic M., Alempijevic D., Curcic D., Dur­mic T.A. Fatal outcome of pica syndrome: an usual case of delayed mortality. Am. J. Forensic Med. Pathol. 2018; 39 (3): 261–263. DOI: 10.1097/PAF.0000000000000409.

[12] Leonard S., Kelly A., Hanna B. Laryngocoele formation after ingestion of fish bone. BMJ Case Rep. 2017; 2017: bcr2016217994. DOI: 10.1136/bcr-2016-217994.

RIGHTS & PERMISSIONS

Fedin A.V., Poyarkova V.S., Aschina L.A., Shkurova N.A.