下咽部异物误诊为颈部感染二例并文献复习

Hypopharyngeal Foreign Body Misdiagnosed as Neck Infection: a Case Report and Literature Review

目的探讨下咽部异物的临床特征、诊治方法及误诊原因,以减少临床误诊误治。方法回顾性分析我院收治的误诊为颈部感染的下咽部异物2例病例资料,并复习相关文献。结果本组2例男性,均以颈部疼痛为主要症状就诊,初诊误诊为颈部感染,给予抗感染对症等治疗效果欠佳。分别行纤维喉镜、颈胸部CT及食管造影等检查,明确诊断为下咽部异物。行颈侧切开术+异物探查取出术+咽瘘修复术,2例术后恢复良好。结论下咽部异物位置隐蔽,临床症状不典型,尤其病程较长时容易误诊。对颈部感染经抗感染治疗效果欠佳的患者,临床应考虑到下咽部异物可能,尽早完善相关检查,以减少误诊误治。

Objective To investigate the clinical features,diagnostic and therapeutic methods,and misdiagnosis causes of hypopharyngeal foreign body in order to avoid misdiagnosis and mistreatment.Methods Clinical data of 2 patients with hypopharyngeal foreign body misdiagnosed as neck infection were analyzed retrospectively,and relevant literature was also reviewed.Results In this group there was two men who suffered from neck pain as the main clinical symptoms.The initial diagnosis was neck infection,and anti-infection and symptomatic treatment was applied with poor effect.Then fiber laryngoscope,computed tomography scan of neck and chest,and esophageal barium meal imaging examination were used respectively to confirm the diagnosis of hypopharyngeal foreign body.Two patients received lateral neck incision,exploration and removal of foreign body and construction of hypopharyngeal fistula.Two patients showed good recovery.Conclusion The location of hypopharyngeal foreign body was hidden,and clinical manifestions were not typical,potentially leading to misdiagnosis,especially in those with long-term disease course.Clinicians should consider the possibility of hypopharyngeal foreign body for the patients who suffered from cervical infection with poor effect of anti-infection treatment,and related examinations should be performed as early as possible to avoid misdiagnosis and mistreatment.