Особливості ведення пацієнтів з абсцесом надгортанника на всіх етапах медичної допомоги

Abstract

An epiglottis abscess is usually the final stage of epiglottis (epiglottitis) and surrounding tissues inflammation and can progress to lifethreatening airway obstruction without treatment. The etiology of the disease can be infectious or non-infectious nature. Both with infectious and non-infectious etiology, swelling of the epiglottis occurs as a result of the accumulation of inflammatory cells in the space between the layer of squamous epithelium and the epiglottis cartilage. The lingual surface of the epiglottis and peri-epiglottis tissues have a large network of lymphatic and blood vessels, which promotes the spread of infection and the subsequent inflammatory reaction. Once the infection begins, the swelling rapidly progresses, involving the entire epiglottis of the larynx (including the epiglottis folds and the epiglottis cartilages). Clinical signs of epiglottitis vary depending on age, severity, and etiology. Purpose – is to describe a clinical case of successful care for a child with an epiglottis abscess and the optimal route of the patient at all levels of medical care. Clinical case. An ambulance delivered a patient G., born in 2005 (17 years old), to the emergency otorhinolaryngology department of the Kyiv City Children’s Clinical Hospital 1. During the examination in the emergency department with indirect laryngoscopy the diagnosis was established: abscess of the epiglottis. An epiglottis abscess was urgently dissected under endotracheal anesthesia. The difficulty of diagnosing an epiglottis abscess was that visualization of the larynx is possible only with the use of instrumental examination methods, such as indirect laryngoscopy. This method is not within the competence of a family doctor. Accordingly, the family doctor, within the limits of his competencies, appropriately used the ISPS-2 international classification, section «R» – respiratory system and code – «76» and made a diagnosis of acute tonsillitis, thereby assuming the infection etiology of the disease. The family doctor, taking into account the severity of the condition, according to the patient’s itinerary, issued a referral for urgent hospitalization, according to the child’s moderate condition. In our opinion, the main reason for achieving a good clinical result was an interdisciplinary approach: a combination of correctly performed diagnostics and timely surgical intervention. We hope that this clinical example, which demonstrates the features of interdisciplinary interaction between specialists, will improve the quality of medical care for patients with epiglottis abscess. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.