Endocrine Abstracts

Purpose: Retropharyngeal abscesses are rare in adults. They most commonly occur in immunocompromised patients as well as older one with systemic diseases like diabetes mellitus. The aim of this study is toidentify the clinical presentation of retropharyngeal abscesses and therapeutic challenges in diabetic patient.

Case report: It is about a 50-year-old man, diabetic (DNID) who consulted us for intense cervicalgia, odynophagia and mixed high dysphagia associated with fever. The patient received oral antibiotic treatment without any improvement. The physical examination found an apyretic and eupneic patient. Oropharynx examination noted halitosis and bulging of the anterior left wall. Neck examination revealed a tender left sided mass of 4 cm. Biological assessment revealed increased white blood cell counts and high sugar blood level. An urgent neck and chest CT scan showed a retropharyngeal circumferential fluid collection more pronounced on the left from the oropharynx down to the hyoid bone, with an important oedema of the vallecula and the epiglottis. Without extending into the mediastinum. The patient underwent early transoral drainage under general anaesthesia with intravenous antibiotic therapy (ceftriaxione + flagyl). Through the first week of hospitalization, blood sugar rates were out of balance. We noted the decrease of the cervical mass however the patient still complained about difficulty swallowing in solid food. A CT scan control at j10 of treatment revealed the increase of the retropharyngeal collection responsible for a significant mass effect on the aero digestive chain. That extend into the superior and posterior mediastinum. Revision surgery was required with transoral drainage and insertion of a tube feed. It was imperative to have the patient restrict oral intake until swelling resolves completely. Per operative bacteriological samples isolated klebsiella pneumonia resistant to cerftriaxone, thus we had to change the treatment by piperacillin–tazobactam. After one month of intravenous tazoactam therapy, we noted a visible clinical improvement and Cervical CT control showed total resolution of the retropharyngeal collection. The patient was discharged after 40 days of hospitalization. One month follow up, the outcome was favourable.

Conclusion: Retropharyngeal abscesses can quickly become a life-threatening emergency. Treatment consists of broad-spectrum antibiotics along with surgical drainage. Management in diabetic patient remains an interdisciplinary challenge including the expertise of specialists in otorhinolaryngology, endocrinologist, radiology, and microbiology.