Perforating pharyngeal injury caused by minor blunt trauma to the neck: A case report

Abstract

Background: Pharyngeal perforation has been documented as a consequence of substantial external force applied to the neck. Such trauma is frequently accompanied by additional organ injury and cervical fracture. In this report, we present an exceptionally rare instance in which minor blunt trauma to the neck resulted in pharyngeal injury without concomitant damage to other organs.

Case presentation: An 18-year-old woman sustained a contusion of the neck due to blunt trauma to the left submandibular region from her bicycle handlebar grip following a collision with a motor vehicle. The patient exhibited a minor contusion of the neck, devoid of active bleeding or hematoma. Furthermore, she did not express any concerns regarding the condition of her neck or throat. A medical examination revealed the absence of abnormal breath sounds in the neck and the absence of any deformity or deviation of the airway. Despite the absence of a foreign body, computed tomography demonstrated the presence of free air extending through the interstitial space between the sternocleidomastoid muscle and larynx, reaching the posterior pharyngeal wall. While the wound was being cleansed with saline solution, the patient reported a sensation of water entering the mouth, which led to the confirmation of a perforation injury to the pharynx. No evidence of leakage was observed during the drinking tests, and the fistula was determined to be unidirectional. The patient was admitted to the hospital for follow-up and discharged on the third day without any additional complications. The outpatient examination conducted on the sixth day following the injury revealed no abnormalities in the physical findings.

Conclusion: Perforating pharyngeal injuries resulting from minor blunt trauma are exceedingly uncommon. In the present case, the water injection test and drinking test were instrumental in both confirming the diagnosis and determining the appropriate treatment plan.

Keywords: Bicycle handlebar grip; Free air; Pharyngeal perforation; Water drinking test; Water injection test.

Fig. 1

(A) A bicycle handlebar grip (a sample photo of the same type and shape). (B) Contusion wound with laceration at the sub-mandibular region.

Fig. 2

Serial computed tomography images of the cervical region. Orange arrows indicate the outer site of neck injury. It demonstrated no residual foreign body but an interstitial air was observed in the neck. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 3

Sequential pictures of three-dimensional transformed images from the computed tomography. Orange arrows indicate the outer site of neck injury. The interstitial air through the soft tissue is painted yellow-green which was extending to the retropharyngeal space. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)