Die Perforation des Hypopharynx als seltene, lebensbedrohliche Komplikation der endotrachealen Intubation

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Abstract
Endotracheal intubation is regarded as the gold standard technique to secure the airway with a low complication rate, however, perforating tracheal or esophageal injuries are rare but severe complications. Two cases of hypopharyngeal perforation after intubation are presented and discussed. While intubation of the first patient was anticipated to be difficult, the second patient did not present any risk factors. One patient developed a typical clinical pattern of difficult swallowing, soft tissue emphysema of the neck, pyrexia, and leukocytosis. The other initially showed minor symptoms but increasing difficulties in swallowing led to the diagnosis of a retropharyngeal abscess. A subsequent acute airway obstruction required emergency invasive airway access. In both cases surgical intervention in combination with antibiotic therapy resulted in complete healing. Physicians performing endotracheal intubation or dealing with patients after intubation, should be aware of the clinical symptoms because only early diagnosis and therapy can prevent development of mediastinitis. In "cannot intubate-cannot ventilate" situations, wide bore transtracheal airway access under local anaesthesia and spontaneous breathing should have priority and temporary tracheotomy should also be considered. To prevent hypopharyngeal injury a thorough evaluation of the "difficult airway" and the atraumatic performance of direct laryngoscopy and endotracheal intubation are mandatory.