Abstract
In recent years, the incidence of retropharyngeal abscess has decreased with the development of effective antibiotics; however, the occurrence rate still remains high in adults due to with complications such as diabetes mellitus.
A 57-year-old male was admitted to our hospital complaining of high fever, severe sore throat, pain upon swallowing, dysphagia and left cervical pain. ENT examination revealed swelling of the soft palate, deviation of the uvula to the right, and an inflammatory swelling of the left arytenoid. However, there was no evidence of airway obstruction.
Based on these findings, the patient was diagnosed to have the lower polar type of peritonsillar abscess with acute lateral pharyngitis, which was considered as an indication for emergency surgery. While he waited for the surgery in the treatment room, the patient developed acute cardiopulmonary arrest. Transoral tracheal intubation and cardiopulmonary resuscitation were immediately performed, and a brain computed tomography (CT) was performed to exclude the presence of a brain disorder. The CT examination revealed a retropharyngeal abscess and a left peritonsillar abscess. After obtaining informed consent, tracheostomy, abscess tonsillectomy and intraoral drainage for the retropharyngeal abscess were performed under general anesthesia, followed by the administration of intravenous antibiotics together with human immunoglobulin. The patient's symptoms and clinical signs gradually resolved and he was discharged 23 days after the surgery without any complications.
We wish to highlight the possibility of occurrence of abrupt airway obstruction in cases with retropharyngeal abscess and peritonsillar abscess and emphasize the need for careful observation using CT in these patients.
