Endocrine Abstracts

Aim

identify the clinical presentation of retropharyngeal abscesses in adults and the therapeutic management modalities.

Materials and methods

We illustrate two cases of retropharyngeal abscess in two elderly subjects collected in the ENT department of the Farhat Hached hospital in Sousse.

Observations

1-/It is about a 70-year-old man, diabetic (DNID) who consulted us for intense cervicalgia, torticollis, and odynophagia. The physical examination found an apyretic and eupneic patient. Oropharynx examination: Halitosis, bulging of the posterior wall with thick pus issue. In profile cervical radiography: thickening of the retropharyngeal space with the presence of an air opacity in relation to the cervical vertebral bodies (C2–C4). The patient had drainage under general anesthesia endoorally with triple antibiotic therapy: Claforan – Fosfomycin- Flagyl. The bacteriological samples did not isolate any germs. A control MRI at J10 of treatment showed: extensive thickening of the soft parts prevertebral retropharyngeal affected by the adjacency of vertebral bodies from C3 to C5 without signs of discitis. The development was favorable. 2-/it is about a patient, 57 years old, diabetic (DNID) who consulted us for mixed high dysphagia associated with cervicalgia and a limitation of the mobility of the cervical spine and the left upper limb. The clinical examination found: torticollis, monoplegia of the left upper limb, tight trismus, a bulge in the posterior wall of the pharynx. Cervical MRI: an important pre-vertebral abscess collection spanning 11 cm responsible for a significant mass effect on the aerodigestive chain and spondylodiscitis advanced to C3–C4 stage. The patient had an endobuccal floating with a safety tracheotomy in front of significant glottic edema and has been given triple antibiotic therapy. The evolution was favorable with regression of trismus, resumption of oral feeding, and regression of the Left upper limb deficit. Decanulation was made at J10.

Conclusion

The pharyngeal abscess must be suspected before any neck stiffness, trismus or dysphagia, associated or not with febrile syndrome especially in immunocompromised persons such as diabetic.