Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2021; 9(25): 7535-7541
Published online Sep 6, 2021. doi: 10.12998/wjcc.v9.i25.7535
Surgical treatment of delayed cervical infection and incomplete quadriplegia with fish-bone ingestion: A case report
Suo-Yuan Li, Ye Miao, Liang Cheng, Ye-Feng Wang, Zhi-Qiang Li, Yu-Bo Liu, Tian-Ming Zou, Jun Shen
Suo-Yuan Li, Ye Miao, Liang Cheng, Ye-Feng Wang, Zhi-Qiang Li, Yu-Bo Liu, Tian-Ming Zou, Jun Shen, Department of Orthopaedic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University; Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
Author contributions: Li SY and Miao Y contributed equally to this work; Li SY and Miao Y conducted all integrated data, edited the figures and wrote the manuscript; Cheng L helped with the data collection; Wang YF, Li ZQ and Liu YB critically reviewed the manuscript; Zou TM provided essential assistance; Shen J directed this study and gave key advice; All authors read and approved the final manuscript.
Supported by 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.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016) and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun Shen, MD, PhD, Professor, Department of Orthopaedic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University; Suzhou Municipal Hospital, No. 26 Daoqian Street, Suzhou 215000, Jiangsu Province, China. 18112603158@163.com
Received: February 23, 2021
Peer-review started: February 23, 2021
First decision: April 13, 2021
Revised: April 20, 2021
Accepted: May 20, 2021
Article in press: May 20, 2021
Published online: September 6, 2021
Abstract
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.

Keywords: Fish bone, Cervical infection, Pyogenic spondylitis, Retropharyngeal abscess, Epidural abscess, Case report

Core Tip: We report a rare case of an elderly female patient with delayed cervical infection and incomplete quadriplegia who had a history of fish bone ingestion. We recommend clinicians be aware of this rare condition that can occur without positive computed tomography findings and mediastinitis. In addition, local complete debridement, sufficient use of antibiotics and placement of a gastric tube for nasal feeding played a vital role in infection control and healing of the laryngopharyngeal wall perforation.