Conservative Management of Pharyngo-Cutaneous Fistula Following Traditional Tonsillotomy: A Case Report

Abstract

Pharyngo-cutaneous fistula is a communication between the pharynx and the skin. It may occur as a result of surgical procedure, deep neck space infections and malignancies of the upper aerodigestive tract. It may also result from perforation by an upper aerodigestive foreign body. We present a 26 year old housewife and mother of 2, presented to our facility with complaints of anterior neck opening discharging pus and food particles following traditional tonsillotomy. Examination revealed chronically ill-looking woman, weak, lying on couch, wasted, dehydrated. Poor oro-dental hygiene, enlarged and inflamed left tonsil, shattered right tonsil with a cavity at the inferior pole exuding pus. Neck examination revealed dyschromic anterior neck skin, features of dermatitis, a supra-sternal wound measuring 2x2cm exuding pus. An assessment of Pharyngo-cutaneous fistula from traditional tonsillotomy was made. Patient was resuscitated, placed on intravenous antibiotics, nasogastric intubation for feeding and daily wound dressing. Full blood count, electrolytes and urea as well as barium fistulography was done. Packed cell volume of 32.1%, White blood cell count of 11.9x109/L, Neutrophilia of 81.6%, platelets count of 141x109/L. Electrolytes, Urea and Creatinine revealed hyponatremia of 133mMol/L, hypokalaemia of 2.8 mMol/L, other parameters were normal. Retroviral screening was non-reactive. Barium fistulography revealed numerous fistulous tracts from the oropharynx, the largest being 13x1.5cm. The airways appear intact. Fistula became closed three weeks after commencement of conservative management. We conclude that pharyngocutaneous fistula from traditional tonsillotomy can be managed conservatively with nasogastric intubation, intravenous antibiotics, wound care, fluid and electrolyte replacement as well as nutritional rehabilitation.