Surgical treatment of delayed cervical infection and incomplete quadriplegia with fish-bone ingestion:A case report  

作　　者：Suo-Yuan Li Ye Miao Liang Cheng Ye-Feng Wang Zhi-Qiang Li Yu-Bo Liu Tian-Ming Zou Jun Shen 

机构地区：[1]Department of Orthopaedic Surgery,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Suzhou 215000,Jiangsu Province,China

出　　处：《World Journal of Clinical Cases》2021年第25期7535-7541,共7页世界临床病例杂志

基　　金：the Key Project of Social Development of Jiangsu province of China-Clinical Frontier Technology,No.BE2017661;the 333 Talents Project of Jiangsu province of China,No.BRA2017057.

摘　　要：BACKGROUND The most commonly ingested foreign body in Asians is fish bone.The vast majority of patients have obvious symptoms and can be timely diagnosed and treated.Cases of pyogenic cervical spondylitis and diskitis with retropharyngeal and epidural abscess resulting in incomplete quadriplegia due to foreign body ingestion have been rarely reported.The absence of pharyngeal or esophageal discomfort and negative computed tomography(CT)findings of fish bone have not been reported.We report the case of an elderly female patient with delayed cervical infection and incomplete quadriplegia who had a history of fish bone ingestion.CASE SUMMARY A 73-year-old woman presented with right neck pain and weakness of four limbs for a week,and had a history of fish bone ingestion and negative findings on laryngoscopic examination one month previously.She did not complain of any pharyngeal or esophageal discomfort.Cervical magnetic resonance imaging showed C4/C5 spondylitis and diskitis along with retropharyngeal and ventral epidural abscesses.No sign of fish bone was detected on lateral cervical radiography and CT scans.The muscle strength of the patient’s right lower limb receded to grade 1 and other limbs to grade 2 suddenly on the 10th day of hospitalization.Emergency surgery was performed to drain the abscess and decompress the spinal cord by removing the anterior inflammatory necrotic tissue.Simultaneously,flexible esophagogastroduodenoscopy was carried out and a hole in the posterior pharyngeal wall was found.The motor weakness of the right lower limb improved to grade 3 and the other limbs to grade 4 within 2 d postoperatively.CONCLUSION This rare case highlights the awareness of the posterior pharyngeal or esophageal wall perforation in patients with cervical pyogenic spondylitis along with a history of fish bone ingestion,even though local discomfort symptoms are absent and the radiological examinations are negative.

关 键 词：Fish bone Cervical infection Pyogenic spondylitis Retropharyngeal abscess Epidural abscess Case report 

分 类 号：R711.32[医药卫生—妇产科学] R68[医药卫生—临床医学]