(1553) An Uncommon Presentation: Traumatic Pharyngeal Perforation Following Consensual Fellatio

Introduction: Pharyngeal perforations are infrequent occurrences, often associated with endoscopic procedures or blunt trauma. Patients typically present with various symptoms, such as tachycardia, hemorrhage, neck pain, dysphagia, odynophagia, hoarseness, and subcutaneous emphysema with crepitus upon cervical palpation. This report describes an unusual case of traumatic pharyngeal perforation in a 45-year-old female following fellatio, leading to retropharyngeal air tracking into the superior mediastinum.

Description: A previously healthy 45-year-old female with no medical history presented to the emergency department with odynophagia, upper chest pain, and difficulty swallowing her saliva, which began approximately 30 minutes after engaging in consensual fellatio with her partner. A CT scan revealed extensive retropharyngeal air extending from the skull base into the superior mediastinum, accompanied by subcutaneous emphysema on the left side of her neck. The perforation was located at the level of the epiglottis, with a soft tissue laceration of the posterior pharynx observed during flexible laryngoscopy. Notably, the oral cavity communicated with the retropharyngeal space, posing the risk of retropharyngeal infection and mediastinitis. The patient received intensive care with NPO status, intravenous clindamycin, and partial parenteral nutrition for one week, resulting in improved CT findings and symptom resolution. Following discharge, she received liquid clindamycin with outpatient otolaryngology follow-up.

Discussion: Traumatic pharyngeal perforations are exceptionally rare, with only one previous case reported following a sexual encounter. Potential complications include retropharyngeal abscess, bacteremia, mediastinitis, pneumonia, and meningitis. In this case, a conservative management approach was chosen, yielding positive outcomes. Conservative management is favored over surgical intervention to mitigate the risk of deep tissue infection, damage to adjacent structures (e.g., laryngeal nerve), and long-term speech and swallowing difficulties. This unique case underscores the importance of considering atypical etiologies for pharyngeal perforations and highlights the successful use of conservative treatment strategies in such cases.