Pharyngeal pouch perforation

Case contributed by Dr Derek Smith

Presentation

Intermittent high dysphagia for solids, and regurgitation.

Patient Data

Age: 60 years
Gender: Male
Fluoroscopy

Left-sided 3 cm pharyngeal pouch arising at the C7 level, retaining contrast throughout the examination.

Normal esophageal and gastric contrast transit (not included).

The patient was later listed for surgical repair of the pouch. Perforation was noted intraoperatively, and the next day the patient was febrile and tachycardic. CT performed to assess for collection/mediastinitis.

Extensive surgical emphysema in the soft tissues of the neck, with a large pocket in the retropharyngeal space. The gas surrounds the esophagus, tracking into the mediastinum.

5 x 3 cm air and fluid filled collection posterior to the esophagus compatible with a clipped pharyngeal pouch.

Gas and inflammatory stranding in the mediastinum, but no organized collection.

Case Discussion

The majority of pharyngeal pouches are managed conservatively, with surgery considered for symptomatic patients. Endoscopic repair is a common route, although there is a reported 2-6% rate of intraoperative perforation.

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