A case report on pharyngeal fistula

Merina1, Subadhra Devi2, Maha Lakshmi3

1Senior Safety Nurse, Kauvery Hospital Cantonment, Trichy, Tamil Nadu

2Nurse Educator, Kauvery Hospital Cantonment, Trichy, Tamil Nadu

3Nursing Superintendent, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

Abstract

A Pharyngeal Fistula is an abnormal epithelial-lined tract that forms a connection between the pharynx and the skin surface or another internal structure. It most commonly arises as a congenital anomaly, often related to branchial apparatus malformation, particularly second branchial cleft anomalies. Acquired fistula may result from infection, trauma, surgical complication, or malignancy. Clinically, patients may present with persistent mucous or purulent discharge in the neck, recurrent infections or difficulty swallowing. We present one such person and his management

Key words: Pharyngeal Fistula; Ryle’s Tube; Gastro Surgeon

Background

A Pharyngeal fistula is a rare condition characterized by an abnormal tract that connects the pharynx to the skin or another internal structure. These fistulas are most often congenital in origin and typically arise due to incomplete obliteration of the branchial apparatus during embryonic development particularly the second branchial cleft. Less commonly pharyngeal fistulas may be acquired resulting from infections, trauma neoplasms or iatrogenic causes such as surgical complications.

Congenital pharyngeal fistulas are usually present in infancy or early childhood. Often as a small opening along the anterior border of the sternocleidomastoid muscle with intermittent mucous or purulent discharge, especially during eating or upper respiratory infections

Case Presentation

A 46-year-old male patient presented with a complex medical history, having sustained a traumatic injury from a fall from height in March 2025. Initially, he was admitted to Thanjavur Medical College for treatment, where he underwent a surgical procedure consisting of Anterior Cervical Discectomy (ACD) and fixation at the C4-C7 level cervical spine injury.

Subsequently, the patient is experiencing symptoms, including persistent and troublesome discharge from the surgical site, with notable presence of food particles in the discharge. A thorough evaluation has led to a diagnosis of an esophago-cutaneous fistula, an abnormal connection between the esophagus and the skin, likely a complication of the previous surgical intervention.

To manage his nutritional needs and facilitate healing, the patient has been maintained on RT tube feeds for the past 4 months, unfortunately, his clinical course has been further complicated by the development of multiple abscesses at the surgical site.

Social History

He does not have any social history

Allergies

Not known medicine and food allergies.

Past Medical History

Nil

Past Surgical history

Fall from Height on C4-C7 ACD + Fixation done on April-25

Physical Examinations

Vital signs

Temp – 98.6 °F, HR – 84 beats/min, RR – 22 breaths/min, BP – 130/80mmhg, Spo2 – 98%, GCS – 15/15

Initial Evaluation

CT brain, Report

CT Brain report

Accidental fall from height. Status post C4-C7 ACDF and lilac homo –out graph plate and screw fixation.

The left side screws of these levels appear just abutting the anterior vertebral cortex

Soft tissue thickening with linear hypo dense tract and few air foci is seen in right side of neck extending from the skin surface towards the post cricoid region- likely fistulous communication.

X-ray Chest: Nil Significant

Surgery

A wide bore fistula led to a large 3.5cm sized opening in the right pharyngeal wall. After discussing with ENT and Gastro Surgeon, the patient underwent removal of C – Spine Implant and repair of pharyngeal fistula.

Prognosis discussed with patient attendees after surgery. Post op, patient was on Ryle’s tube feeding. Post Op x-ray taken, dressing changed. The patient was treated with IV fluids, antibiotics, anticoagulants and other supportive measures. With all medical measures, the patient symptomatically improved. Patient was advised for close follow-up on OPD

Skilled Nursing Care

  • Regular monitoring of the overall condition and reporting deviations in health status.
  • Nutritional needs: Ryle’s Tube feeding given.
  • Positioning: The head end elevation from 30 degrees up to 45 degrees in order to prevent swelling
  • on the face and orbital edema. And frequent position changes are done to prevent pneumonia.
  • Early ambulation: Ambulated the patient to the chair to improve his muscle strength.
  • Pressure ulcer risk assessment measures are taken to prevent bed sore.
  • Sequential compression devices are applied to prevent deep vein thrombosis.
  • Hand hygiene measures taken
  • Physiotherapy exercise is given to evaluate the muscle strength balance and mobility.
  • Educating the patient and relatives on signs of complication wound care
  • Dressing maintains the surgery site

Discharge Medications

S.noDrug NameStrengthFrequencyRoute of AdminRelationship with mealDays
MAN
1Inj. Meropenem1gm111IV4 days
2Tab. Pantocid40 mg101RTBefore food10 days
3Tab. Paracetamol1gm111RTAfter food7 days
4Tab. Domstal10mg111RTBefore food3 days
5Syp. Alex2 tspn111RTAfter food3 days
6Ensure Powder2 scoops111RTWith milk / waterTill review

Conclusion

Pharyngeal fistulas, though rare, represent a significant congenital or acquired anomaly with potential implications for airway, feeding, and infection risk. Early recognition through clinical presentations and appropriate imaging is crucial for timely intervention. Surgical excision remains the definitive treatment, with excellent prognosis when properly managed. Multidisciplinary care involving otolaryngology, radiology, and pediatrics ensures optimal outcomes and minimizes the risk of recurrence or complications. Ongoing follow up is essential to monitor healing and functional restoration.

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