Adaptation of Endoluminal Vacuum Therapy via Extra-Luminal Access in the Treatment of a High Pharyngeal Fistula: Technical Feasibility and Outcome.

backgroundPerforation of the piriform sinus is a rare but severe clinical event that can lead to cervico-thoracic mediastinitis, a life-threatening condition requiring urgent multidisciplinary intervention. Among its etiologies, accidental ingestion of foreign bodies, including dental prostheses, is uncommon but poses significant risks due to the anatomical vulnerability of the hypopharyngeal structures.

methodsWe report a rare case of right piriform sinus perforation secondary to the ingestion of a dental prosthesis, complicated by cervico-mediastinitis, sepsis, tracheostomy, and sacral pressure ulcer. The clinical course required emergency surgical intervention and intensive supportive care.

resultsA novel aspect of this case was the use of the Endoscopic Vacuum-Assisted Closure (EVAC) irrigation system as an adjunctive technique in the management of deep cervical drainage. Rather than approaching the fistula from within the lumen, the team created a controlled external drainage system, adaptation of the vacuum-assisted closure therapy directly over the fistulous tract.

conclusionsThis case highlights the importance of early diagnosis, high clinical suspicion and coordinated management in the treatment of piriform sinus perforations. It also illustrates the potential applicability of modern technologies such as negative pressure irrigation in the complex management of deep neck infections and mediastinitis.