Anesth Pain Med.  2018 Oct;13(4):463-467. 10.17085/apm.2018.13.4.463.

Pharyngeal reperforation following incentive spirometry: A case report

• Jeon S
• Hong JM
• Kwon JY
• Hwang BY
• Yun G

• KMID: 2436009
• DOI: http://doi.org/10.17085/apm.2018.13.4.463

Abstract

Despite its widespread use, complication of incentive spirometry has been rarely reported. We report a case of pharyngeal reperforation following incentive spirometry. A 75-year-old female, had a history of long-term steroid use, entered the intensive care unit for maintenance of mechanical ventilation following surgical repair of a pharyngeal perforation. After ventilator weaning, incentive spirometry was implemented on postoperative day 4. Immediately after incentive spirometry use, patient's neck began to swell, and subcutaneous emphysema was palpated. Pharyngeal reperforation was suspected on neck computed tomography, and emergency surgery was performed. Surgery revealed a 3-cm long rupture from the hypopharynx to the esophagus. The causes were thought to be delayed wound healing due to long-term steroid use and a sudden increase in pharyngeal pressure due to incentive spirometry. In conclusion, particular attention should be paid when using incentive spirometry after head and neck surgery in patients with a history of long-term steroid use.

Keyword

Head and neck surgery; Incentive spirometer; Incentive spirometry; Pharyngeal perforation; Steroids

MeSH Terms

Aged
Emergencies
Esophagus
Female
Head
Humans
Hypopharynx
Intensive Care Units
Motivation*
Neck
Respiration, Artificial
Rupture
Spirometry*
Steroids
Subcutaneous Emphysema
Ventilator Weaning
Wound Healing
Steroids

Figure

• 

  Fig. 1 Neck computed tomography (CT) before and after incentive spirometry. Before ventilator weaning, neck CT was performed (A, B) to see the postoperative course and there were no abnormal findings. (C, D) are neck CT findings when extensive subcutaneous emphysema occurred after using incentive spirometry. Air around retropharyngeal space, pneumomediastinum, and extensive subcutaneous emphysema were observed.

• 

  Fig. 2 Chest X-ray after using incentive spirometry. From the neck to the chest, extensive subcutaneous emphysema was observed.

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