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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

Operative finding under the endoscopy which showed the nasopharyngeal abscess
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Figure 0002: Operative finding under the endoscopy which showed the nasopharyngeal abscess

Mentions: We took an endonasal endoscopic approach to treat the suprasellar and nasopharyngeal lesion. Gray brownish necrotic tissue of soft to firm nature was removed [Figure 2]. Pathology showed extensive acute gangrenous inflammation and sequestrum of bone. The culture from this specimen grew E.coli. Two weeks of Flomoxef therapy was given and the patient was discharged 22 days after operation and she presented with only mild left sixth nerve palsy. Two months later, MRI scan with DWI sequences showed residual abscesses in the left cavernous sinus and parasellar region [Figure 1b].


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)

Operative finding under the endoscopy which showed the nasopharyngeal abscess
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0002: Operative finding under the endoscopy which showed the nasopharyngeal abscess
Mentions: We took an endonasal endoscopic approach to treat the suprasellar and nasopharyngeal lesion. Gray brownish necrotic tissue of soft to firm nature was removed [Figure 2]. Pathology showed extensive acute gangrenous inflammation and sequestrum of bone. The culture from this specimen grew E.coli. Two weeks of Flomoxef therapy was given and the patient was discharged 22 days after operation and she presented with only mild left sixth nerve palsy. Two months later, MRI scan with DWI sequences showed residual abscesses in the left cavernous sinus and parasellar region [Figure 1b].

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