Retropharyngeal emphysema is a potentially life threatening condition which may
require urgent diagnosis and intervention. It has been documented to occur
following trauma to the aerodigestive tract and is usually accompanied by
subcutaneous emphysema of the cervical region. This condition may be complicated
by mediastinal emphysema and pneumomediastinum. Foreign body ingestion is
quite common in little children and in this environment; a cultural practice
is for mothers or other caregivers to attempt to remove these foreign bodies
by forcing their finger(s) down the oropharynx and Hypopharynx of these young
children. This usually results in injuries to these anatomical sites.
Retropharyngeal emphysema complicating this practice is rarely reported. Case
presentation: We present the case of a 4-year-old Nigerian boy who presented
with stridor and severe dyspnoea following repeated attempts at removal of a
purportedly ingested foreign body by his mother. Examination revealed oedema of
the soft palate with small multiple bleeding shallow lacerations of the oropharyngeal
walls. Oxygen therapy was commenced and preparations for urgent upper airway
intervention made. Soft tissue neck X-ray revealed retropharyngeal and
subcutaneous emphysema with upper airway compromise. Conservative treatment
with high dose steroids and antibiotics led to a gradual resolution of the
condition. Conclusion: This is a rarely reported complication of this relatively
common socio-cultural “foreign body removal method”. Public awareness is
required to stop this potentially life threatening practice.
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