Spontaneous Rupture of the Pharynx.

The patient was an obese housewife aged 50 years. The day her pharynx ruptured, her lunch consisted of chips and gravy followed by a steamed fruit pudding which she had made herself. To use her own words, she 'swallowed a mouthful of pudding unexpectedly'. The pudding seemed to stick in her throat and she was immediately seized with intense pain on the left side of the neck. She was at once aware also of a swelling about the size of an egg on the left side of the neck. She thrust her fingers down her throat to induce vomiting and brought up some blood. The pain became even worse and the swelling increased. She was rushed to hospital on the pillion of a motor cycle. This was her first experience of this mode of transport. At the hospital, which she reached one hour after the onset of pain and swelling, she was found to be moderately shocked. She complained of agonizing pain all round her neck, between the shoulder blades, and over the right shoulder blade. There was extensive surgical emphysema of the neck. The pharynx was inspected but no cause was found to account for her condition. She was transferred to the Thoracic Surgical Unit of the Bradford Royal Infirmary about four hours after the beginning of the episode. The pain was so severe that she was unco-operative. She said she just wanted to die. Her blood pressure was 130/70 mm. Hg. (The blood pressure recorded after recovery was 180/110 mm. Hg.) There was gross swelling due to surgical emphysema which involved both sides of the neck, the face, and the upper part of the chest anteriorly. The surgical emphysema appeared to be spreading. The only additional history obtained at this stage was that she had suffered from chronic bronchitis and that she had had a goitre for many years. She was given gastrografin to swallow and a radiograph of the neck was taken two minutes later. Most of the opaque medium passed down the oesophagus but some of it remained in the neck just above the level of the cricoid cartilage. The gastrografin lodging in the neck was irregularly disposed and extended laterally on the left side.