A Case of Surgery to Remove Pyriform Sinus Fistula with Some Ingenuities

Abstract

Pyriform sinus fistula (PSF) is a congenital fistula. It usually manifests as acute suppurative thyroiditis or neck abscess, and the diagnosis is often made in patients presenting with these infections. Patients with a previous history of infection are candidates for surgical treatment. Our patient was a 34-year-old man who presented to another doctor with swelling and pain of the anterior neck. He was initially diagnosed as having subacute thyroiditis and treated with a corticosteroid. However, he presented at a later date with a neck abscess, based on which he was diagnosed as having a PFS and referred to our department. We treated his PFS by surgical resection; the postoperative course was favorable, and there has been no recurrence. Sometimes, it is difficult to identify PFS due to the presence of inflammatory scarring. In the case reported herein, we accomplished complete surgical resection of the PSF with some careful prior preparation, including asking the patient to drink Pyoktanin blue solution before the operation, using a laryngoscope and gastroscope to observe the hypopharynx, introducing a thin tube into the PSF, and so on. These ingenuities are very useful to the success of operation for PFS.