A Remarkable Recovery: Treating a Retropharyngeal Abscess at SSB Heart and Multispeciality Hospital

January 4, 2024

At SSB Heart and Multispeciality Hospital, a complex medical case was expertly managed under the guidance of Dr. Pradeep Poswal. A 68-year-old male patient, grappling with a severe retropharyngeal abscess, underwent a successful treatment, showcasing the hospital's commitment to advanced healthcare.

Patient's Medical Challenge

The patient presented with odynophagia (pain during swallowing) and absolute dysphagia (complete inability to swallow), which had progressively worsened over 4-6 weeks. His medical history was significant for Type 2 diabetes mellitus, managed on oral hypoglycaemic agents for six years. A recent fever episode had resulted in a blood culture positive for Klebsiella species, a type of bacteria often involved in infections.

Physical examination by Dr. Poswal and his team revealed a notable bulge in the posterior pharyngeal wall (back wall of the throat), though his laryngeal examination (vocal cords and voice box check) was normal, with no breathing or voice difficulties. Notably, there was no swelling visible on the outside of his neck.

Laboratory results showed raised total counts, indicative of an infection, and his HbA1c was 8.2, suggesting suboptimal diabetes control. A CECT scan of the neck, a specialized imaging technique, displayed a large (3.1 cm x 3.1 cm x 6.2 cm) abscess (a collection of pus) in the retropharyngeal space. This abscess was pressing against the air passage in the throat but had not ruptured, a crucial factor in planning treatment.

The Road to Recovery

Under Dr. Poswal's leadership, the patient was treated with a combination of antibiotics: ceftriaxone, metronidazole, and amikacin. The pivotal part of the treatment involved draining the abscess through a transoral incision (an incision made inside the mouth), performed under general anesthesia. This procedure successfully drained about 100 ml of pus, and the cavity was cleansed with betadine, an antiseptic solution.

For visual reference and medical records, a pre-operative X-ray of the neck (Image 1) was taken, clearly showing the retropharyngeal abscess. This image serves as an educational tool, illustrating the severity of the condition upon the patient's arrival.

Image 1: Pre-operative X-ray neck shows Retropharyngeal abscess.

Post-operatively, the patient received intravenous antibiotics and nutrition through Ryle’s tube feeding. Remarkably, the incision site spontaneously healed after continuous drainage of pus over five days. The culture of the drained pus confirmed the presence of Klebsiella pneumoniae, a type of bacteria, and was negative for AFB (a test for tuberculosis).

The effectiveness of Dr. Poswal's treatment approach was validated by a post-operative X-ray (Image 2), which depicted the healed abscess, indicating a successful resolution of this serious medical condition.

Image 2: Post-operative X-ray Neck shows healed retropharyngeal abscess.

This case at SSB Heart and Multispeciality Hospital under Dr. Pradeep Poswal's expert care is a prime example of the hospital's commitment to delivering high-quality, personalized healthcare. It underscores the importance of early diagnosis, the effective application of medical expertise, and the utilization of advanced treatment methodologies in managing complex medical conditions, ultimately leading to successful patient outcomes.