Double trauma of the pharynx: fencing sword vs pull-up bar

Abstract

Aim of the study: To present a case report of a double trauma to the pharynx and to emphasize the importance of anamnesis in understanding clinical and radiological findings. Case description: A 17-year-old patient fell from the pull-up bar onto a padded surface, hitting the left side of his head and neck. The left side of the neck was numb for an hour. The next day he slept poorly due to the pain, the left side of his neck began to swell. After a few days he arrived at the emergency center where CT was performed: abundant air inclusions in the neck and pneumomediastinum were observed. An X-ray contrast swallow examination was performed: hyoid bone fracture and inflow of contrast material from the esophagus were found. The patient was further treated in the pediatric surgery with antibiotics, painkillers, and feeding through nasogastric. But it was unclear how this sharp injury to esophagus happened. The patient was asked again about the trauma and he specified that a week ago he also injured his throat with a fencing sword, he fell on it with his mouth open. At first, the patient decided not to tell about this injury because nobody asked him specifically. During pharyngoscopy, a wound with granulation was observed in the posterior wall of the pharynx. Patient follow-up: the condition improved in dynamics, the nasogastric tube was removed, oral feeding was initiated and the patient was released home without additional interventions. Conclusions: Most of oropharyngeal injuries heal without any surgical interventions. Therefore, it is very important to correctly assess the mechanism of trauma in predicting its consequences.