a20 yr old down's syndrome girl with uncontrolled epilepsy was brought by her family for rapidly progressing neck pain and dysphagia. endoscopy very edematous pharynx and larynx. xray neck showed prevertebral widening with gas formation, straightening of cervical vertebrae and suspected foreign body at post cricoid level. ? large retropharyngl abcess on questioning the parents they give history that she hurriedly had fish a few days ago. As it was a high risk condition she wasn't taken up at many places. it was heart wrenching looking at her , she's unable to understand what's happening to her all that she wasn't able to swallow anything and had excruciating pain. she was taken up for exploration under GA under high risk thanks to my anaesthetist who dared to give her anesthesia. intra op big sharp fish bone was found at post cricoid region anteriorly abutting laryngeal mucosa posteriorly piercing pharyngeal mucosa, after it's removal 20 ml of foul smelling pus evacuated. it was very difficult to make her retain her ryles tube post surgery, with a lot of her mischief we managed to keep it for 4 days and she made a good diet speedy recovery. *parents of MR children should never leave them unattended when they are consuming food with Sharp particles like meat, and small round food items (can cause aspiration). *we have to take calculated risks *retropharyngeal abcess should be managed before they turn into near fatal mediastinitis.

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sir, thank you for highlighting such a case. very informative

thanks future doc
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Great job

thanks future doc
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Thanks for sharing great job !

thanks madam
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Dr siddharth, a very good job, for managing a fb induced retropharyngeal abscess!!! Onething i want to add within ur management!! Don't only deal with the site of impaction in case of any space abscess, u have to manage other pockets too, go for serial x ray soft tissue neck ap and lateral view, as i can see u haven't consider the chance of tracheostomy requirement during the ot procedure!! For this case u required incision along the both sides of the median raphe and definitely a tracheostomy is required, coz the patient is MR case, aspiration difficulty cannot be predicted from this retarded case!! Anyway, thank u for sharing it..

Wonderful enlightening post on FBs in MR Mentally Retarded Children. It's an eye opener for all doctors and parents and attendants of MR Children like Down's Syndrome. Wonderful job dear Siddharth and special thanks to the Anaesthetist who dared to give anaesthesia at a critical juncture. I know your dynamism Siddharth. Hats off to your skills that saved a life. Keep going on and on. All the best in all your endeavors.

Thanks sirji
1

Good job keep it up.

thank you doctor
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Agree with Dr. Mohan.

Thanks Dr Parvez
1

Good job Dr.Siddharth

thanks doc
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great job sir....

thanks doc
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HATS OFF!! Doc!!

thanks doc
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