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Acute retropharyngeal abscess in children
1Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. abuth@anpa.net.ng
Insights
Acute retropharyngeal abscesses are rare but serious in infants. Prompt diagnosis and management, including drainage and antibiotics, are crucial to prevent severe complications and mortality.
Area of Science:
- Pediatrics
- Infectious Diseases
- Otolaryngology
Background:
- Acute retropharyngeal abscesses (ARAs) are uncommon due to widespread antibiotic use.
- ARAs primarily affect infants and young children, often presenting with respiratory distress.
Purpose of the Study:
- To review the features and management of pediatric ARAs.
- To re-emphasize awareness of this rare but potentially fatal condition.
Main Methods:
- Retrospective case series of ten children with ARA over a 10-year period.
- Analysis of clinical presentation, management strategies, and outcomes.
- Diagnostic imaging included lateral cervical radiography.
Main Results:
- Most patients were under 12 months and presented with respiratory obstruction.
- Pre-hospital antibiotic use resulted in sterile pus cultures in most cases.
- Management involved surgical drainage (external or oral), needle aspiration, or tracheostomy.
- Two children died, one from airway obstruction and another from post-operative laryngeal spasm.
Conclusions:
- Pediatric ARAs require prompt recognition and intervention, particularly in developing countries.
- Effective management involves airway control, abscess drainage, and appropriate antibiotic therapy.
- Awareness among healthcare providers is essential to improve outcomes for this rare condition.
Abstract:
Due to the wide availability of effective antibiotics, acute retropharyngeal abscesses have become increasingly rare. This is a retrospective report of ten children with this condition, managed over a 10-year period. Nearly all were aged 12 months or less and presented only when respiratory obstruction had developed. Owing to administration of antibiotics at home, cultures of pus specimens were sterile in most cases. The retropharyngeal space was widened on lateral, plan cervical radiography in five children. Four had drainage by external cervical incision, and in four drainage was by mouth, all under general anaesthesia. Tracheostomy was necessary in one child who developed respiratory obstruction and the abscess was drained by needle aspiration. One child died before drainage of the abscess. Parenteral antibiotics were administered also for 5 days. There was no recurrence in any case. Laryngeal spasm occurred post-operatively in two children, leading to death in one. Overall, two children died. The features and management of the disease are reviewed briefly to re-awaken awareness of the condition, especially in developing countries where it is most likely to be seen at the present time.