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Nasopharyngeal gangrenous abscess with skull base extension caused by Escherichia coli after esophageal dilatation for esophageal reconstruction.

Lau WH, Chang WC, Tsuei YS, Cheng WY, Chao SC, Shen CC - Surg Neurol Int (2010)

Bottom Line: Endonasal endoscopic surgery was performed to treat the lesion and a successful result was obtained.Bacterial culture showed Escherichia coli.Symptoms improved after the operation and treatment with antibiotics.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Cheng Ching General Hospital, Taichung, Taiwan.

ABSTRACT

Background: Esophageal dilatation is the most widely used treatment option for the management of esophageal strictures. Complications include bleeding, brain abscess, esophageal perforation and bacteremia. Nasopharyngeal gangrenous abscess after the esophageal dilatation is very rare. Endonasal endoscopic surgery was performed to treat the lesion and a successful result was obtained.

Case description: A 59-year-old woman with a previous history of dilatation for esophageal stricture was admitted with a low-grade fever, headache, neck pain and cranial nerve abnormalities including sixth nerve palsy. Imaging studies aroused suspicion of necrotic retropharyngeal tumor with clivus, condylar process and cavernous sinus invasion. Biopsy with a pharyngosope was performed by an ENT doctor. The pathology showed acute necrotic inflammation, tissue granulation and bacteria colonies. Navigation with endonasal endoscopic surgery was chosen to treat the skull base and nasopharyngeal abscess. Bacterial culture showed Escherichia coli. Symptoms improved after the operation and treatment with antibiotics.

Conclusion: A nasopharyngeal gangrenous abscess with extension to the skull base in the case of esophageal reconstruction after esophageal dilatation is extremely rare. Physicians dealing with esophageal stricture should keep in mind that a nasopharyngeal abscess is a potential complication of esophageal dilatation.

No MeSH data available.


Related in: MedlinePlus

(a) MRI scan of sella. Preoperative axial, coronal and sagittal images after intravenous administration of gadolinium diethylenetriamine penta-acetic acid are shown. Thickening of the nasopharyngeal wall with irregular contrast enhancement is seen. Ill-defined enhancement over the skull base including the clivus, bilateral petrosal apex and condylar process of the occipital bone is also seen. Prominent enhancement over the left cavernous sinus and left parasellar region can also been seen. (b) Two months postoperative axial, coronal, and sagittal postgadolinium images show improvement. Residual left sixth nerve palsy was presented after the surgery, while other cranial neurolopathies improved. There were some residual abscesses in the left cavernous sinus and parasellar region (arrow)
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Figure 0001: (a) MRI scan of sella. Preoperative axial, coronal and sagittal images after intravenous administration of gadolinium diethylenetriamine penta-acetic acid are shown. Thickening of the nasopharyngeal wall with irregular contrast enhancement is seen. Ill-defined enhancement over the skull base including the clivus, bilateral petrosal apex and condylar process of the occipital bone is also seen. Prominent enhancement over the left cavernous sinus and left parasellar region can also been seen. (b) Two months postoperative axial, coronal, and sagittal postgadolinium images show improvement. Residual left sixth nerve palsy was presented after the surgery, while other cranial neurolopathies improved. There were some residual abscesses in the left cavernous sinus and parasellar region (arrow)

Mentions: Two months before admission, she complained of dysphagia, and esophageal dilatation was performed due to the stricture. One month later, she developed diplopia, slurred speech and dysphasia. Low-grade fever and whitish rhinorrhea were also noticed. On neurological examination, the patient was alert and oriented. She had severe neck pain, left sixth nerve palsy, mildly slurred speech and dysphagia. Other cranial nerves, including III, IV, V, had no defect. Muscle strength was normal in upper extremities. The deep-tendon reflexes were normal bilaterally. Sensory examination showed nothing unusual. Laboratory studies were within the normal range. A plain chest film showed a supradiaphragmatic gastric bulb. C-reactive protein levels were elevated to 3.6mg/dL (normal range 0.0-0.8 mg/dL). Magnetic resonance imaging (MRI) of sellar region disclosed a thickening of the nasopharyngeal wall with irregular contrast enhancement. Ill-defined enhancement was seen over the skull base including the left cavernous sinus, left parasellar region, clivus, bilateral petrosal apex, condylar process of the occipital bone and C1 vertebra [Figure 1a]. Nasopharynx carcinoma was first considered. A nasopharyngoscopy was performed by an ENT doctor and showed a necrotic lesion over the left nasopharynx. The pathological report of a punch biopsy showed acute necrotic inflammation, tissue granulation and bacteria colonies.


Nasopharyngeal gangrenous abscess with skull base extension caused by Escherichia coli after esophageal dilatation for esophageal reconstruction.

Lau WH, Chang WC, Tsuei YS, Cheng WY, Chao SC, Shen CC - Surg Neurol Int (2010)

(a) MRI scan of sella. Preoperative axial, coronal and sagittal images after intravenous administration of gadolinium diethylenetriamine penta-acetic acid are shown. Thickening of the nasopharyngeal wall with irregular contrast enhancement is seen. Ill-defined enhancement over the skull base including the clivus, bilateral petrosal apex and condylar process of the occipital bone is also seen. Prominent enhancement over the left cavernous sinus and left parasellar region can also been seen. (b) Two months postoperative axial, coronal, and sagittal postgadolinium images show improvement. Residual left sixth nerve palsy was presented after the surgery, while other cranial neurolopathies improved. There were some residual abscesses in the left cavernous sinus and parasellar region (arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2958327&req=5

Figure 0001: (a) MRI scan of sella. Preoperative axial, coronal and sagittal images after intravenous administration of gadolinium diethylenetriamine penta-acetic acid are shown. Thickening of the nasopharyngeal wall with irregular contrast enhancement is seen. Ill-defined enhancement over the skull base including the clivus, bilateral petrosal apex and condylar process of the occipital bone is also seen. Prominent enhancement over the left cavernous sinus and left parasellar region can also been seen. (b) Two months postoperative axial, coronal, and sagittal postgadolinium images show improvement. Residual left sixth nerve palsy was presented after the surgery, while other cranial neurolopathies improved. There were some residual abscesses in the left cavernous sinus and parasellar region (arrow)
Mentions: Two months before admission, she complained of dysphagia, and esophageal dilatation was performed due to the stricture. One month later, she developed diplopia, slurred speech and dysphasia. Low-grade fever and whitish rhinorrhea were also noticed. On neurological examination, the patient was alert and oriented. She had severe neck pain, left sixth nerve palsy, mildly slurred speech and dysphagia. Other cranial nerves, including III, IV, V, had no defect. Muscle strength was normal in upper extremities. The deep-tendon reflexes were normal bilaterally. Sensory examination showed nothing unusual. Laboratory studies were within the normal range. A plain chest film showed a supradiaphragmatic gastric bulb. C-reactive protein levels were elevated to 3.6mg/dL (normal range 0.0-0.8 mg/dL). Magnetic resonance imaging (MRI) of sellar region disclosed a thickening of the nasopharyngeal wall with irregular contrast enhancement. Ill-defined enhancement was seen over the skull base including the left cavernous sinus, left parasellar region, clivus, bilateral petrosal apex, condylar process of the occipital bone and C1 vertebra [Figure 1a]. Nasopharynx carcinoma was first considered. A nasopharyngoscopy was performed by an ENT doctor and showed a necrotic lesion over the left nasopharynx. The pathological report of a punch biopsy showed acute necrotic inflammation, tissue granulation and bacteria colonies.

Bottom Line: Endonasal endoscopic surgery was performed to treat the lesion and a successful result was obtained.Bacterial culture showed Escherichia coli.Symptoms improved after the operation and treatment with antibiotics.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Cheng Ching General Hospital, Taichung, Taiwan.

ABSTRACT

Background: Esophageal dilatation is the most widely used treatment option for the management of esophageal strictures. Complications include bleeding, brain abscess, esophageal perforation and bacteremia. Nasopharyngeal gangrenous abscess after the esophageal dilatation is very rare. Endonasal endoscopic surgery was performed to treat the lesion and a successful result was obtained.

Case description: A 59-year-old woman with a previous history of dilatation for esophageal stricture was admitted with a low-grade fever, headache, neck pain and cranial nerve abnormalities including sixth nerve palsy. Imaging studies aroused suspicion of necrotic retropharyngeal tumor with clivus, condylar process and cavernous sinus invasion. Biopsy with a pharyngosope was performed by an ENT doctor. The pathology showed acute necrotic inflammation, tissue granulation and bacteria colonies. Navigation with endonasal endoscopic surgery was chosen to treat the skull base and nasopharyngeal abscess. Bacterial culture showed Escherichia coli. Symptoms improved after the operation and treatment with antibiotics.

Conclusion: A nasopharyngeal gangrenous abscess with extension to the skull base in the case of esophageal reconstruction after esophageal dilatation is extremely rare. Physicians dealing with esophageal stricture should keep in mind that a nasopharyngeal abscess is a potential complication of esophageal dilatation.

No MeSH data available.


Related in: MedlinePlus