Retropharyngeal abscess complicating 'innocent' foreign body ingestion

An adult patient presented to the emergency department with pharyngeal discomfort on swallowing, persisting several hours after lunch. Transnasal fibre-optic endoscopy performed by an otolaryngologist identified a hypopharyngeal foreign body, and the stalk of a dry leaf partially penetrating the mucosa was easily removed under general anaesthesia. Symptoms regressed completely and the patient was discharged. Two days later he presented again, reporting slight dysphagia without odynophagia or other associated symptoms. Meticulous physical examination by the same otolaryngologist revealed this time a slight asymmetry of the posterior pharyngeal wall. A history of recent pharyngeal trauma and findings on clinical examination raised clinical suspicion of retropharyngeal abscess which was supported by CT scan findings. The diagnosis was confirmed in the operating theatre where a purulent collection was drained under new general anaesthesia.