Retropharyngeal abscess: a clinical review

Retropharyngeal abscesses are uncommon but potentially lethal infections, especially in the paediatric population under the age of five years. Abscesses in this group are classically secondary to upper respiratory infections especially oropharyngeal infections, while in the adult group they are usually secondary to trauma, foreign bodies, or as a complication of dental infections. Early diagnosis and the wide spread use of antibiotics have made these infections less common today. Between the years 1985-1996, 19 cases of retropharyngeal abscesses were treated in our department. Factors such as age, sex, aetiology, presenting signs, symptoms, methods of diagnosis, treatment and complications were reviewed. Thirty-two per cent of the cases were secondary trauma. A lateral neck film showing widening of the prevertebral space was the most important diagnostic tool, computed tomography (CT) scan was used in 63 per cent of cases to verify the signs of an abscess and to provide more accurate anatomical localization. Thirteen cases required surgical drainage. The single most commonly-isolated pathogen was Streptococcus pyogenes. There were no deaths and only one recurrence requiring repeated surgical drainage. One case was complicated by a spinal canal abscess. We also report two cases of retropharyngeal abscess in children caused by swallowing of unusual foreign bodies.