Endoscopic fibrin sealing of congenital pyriform sinus fistula
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B Cigliano1, L Cipolletta, N Baltogiannis
1Department of Pediatric Surgery, Federico II Children's University Hospital, 5 Pansini Street, 80131 Naples, Italy. cigliano@cds.unina.it
Insights
Recurrent suppurative thyroiditis in a child was successfully treated by obliterating a rare pyriform sinus fistula with fibrin glue. This endoscopic approach offers a novel minimally invasive option for managing this congenital malformation.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Imaging
Background:
- Pyriform sinus fistula is a rare congenital anomaly of the branchial apparatus.
- It often presents as recurrent cervical inflammation, such as suppurative thyroiditis, particularly in infants.
- Delayed diagnosis can lead to persistent or recurring infections.
Observation:
- A case of recurrent suppurative thyroiditis in a 9-year-old girl was investigated.
- A barium meal contrast study identified the fistula tract during a quiescent infection phase.
- Direct endoscopy revealed the internal fistula opening at the apex of the left pyriform fossa.
Findings:
- The pyriform sinus fistula was successfully treated by endoscopic obliteration using fibrin glue.
- This represents the first reported case of managing suppurative thyroiditis secondary to pyriform sinus fistula with endoscopic fibrin glue injection.
- Diagnostic imaging, including barium swallow, was crucial in identifying the fistula during latency.
Implications:
- Endoscopic obliteration with fibrin glue provides a minimally invasive treatment option for pyriform sinus fistulas.
- This technique may reduce recurrence rates of suppurative thyroiditis linked to this malformation.
- Highlights the importance of considering congenital anomalies in recurrent pediatric infections.
Abstract:
Pyriform sinus fistula is a very rare branchial apparatus malformation, often appearing in the form of a cervical inflammatory process (abscess or suppurative thyroiditis), especially in infants. Failure to diagnose this lesion may result in unexpected recurrence. A case of recurrent suppurative thyroiditis caused by pyriform sinus fistula in a 9-year-old girl is reported. In the latency period of infection, the fistula tract was identified by a barium meal contrast study. Direct endoscopy showed the fistula internal orifice at the apex of the left pyriform fossa. The fistula was completely obliterated by injection of fibrin glue. Suppurative thyroiditis is reported mainly in the pediatric literature, and the reported case is the first to be managed endoscopically by injection of fibrin adhesive.