Hypopharyngeal Fistula Complicating Hemithyroidectomy for Follicular Carcinoma
- Presentation Speakers / Moderators
Background: Hypopharyngeal fistula is a rare complication of thyroidectomy. This is the second documented case of this complication and the first complicating follicular carcinoma.
Clinical Case: A 20 year old female presented with a U3 Thy3a lesion in the left thyroid lobe and underwent an uneventful left hemithyroidectomy. She represented 3 days post-operatively with a sore throat, hoarse voice and wound discharge. Nasal endoscopy revealed a left vocal cord paresis. She was treated for a presumed wound infection with parenteral antibiotics but failed to improve. On day 2 of her admission, the wound was explored, cleaned and closed. She recovered transiently but deteriorated rapidly 3 days later. A further neck exploration was performed and the wound was found to contain pus and white debris. A CT neck with oral contrast was performed and a hypopharyngeal cutaneous fistula was found. The patient was kept nil by mouth and a nasogastric tube was inserted for a total admission of 6 weeks. CT neck with oral contrast performed 5 weeks after discharge showed complete resolution of the fistula without further surgical management. Histological examination of the initial specimen showed follicular carcinoma with angioinvasion with R1 resection margins extending to the tracheal limit. She underwent an uneventful completion thyroidectomy and radioactive iodine therapy.
Conclusions: Hypopharyngeal fistula is an uncommon complication but should be considered in patients with non-resolving turbid discharge following thyroidectomy. We have successfully managed this patient using a conservative approach but there is no current consensus surrounding management of this rare complication.
Two Approaches to Level 5 Neck Dissection
- Jeff Blumberg