Abstract
RATIONALE: Retropharyngeal abscesses (RPAs) following fish bone ingestion are extremely rare in infants under 2 years, with limited cases reported worldwide. Given the anatomical vulnerability and diagnostic challenges faced by infants, this gap in knowledge is critical. No previous reports have described life-threatening delayed RPA caused by endoscopic pharyngeal injury without a retained foreign body, which is a critical omission in the postoperative safety protocols. Our study details a life-threatening delayed RPA caused by posterior pharyngeal wall injury after endoscopic removal of a fish bone, highlights the critical role of postoperative imaging, which is frequently overlooked in pediatric practice, and contributes to the sparse literature on severely delayed RPAs in infants after fish bone ingestion. PATIENT CONCERNS: An 18-month-old girl presented with 6 months of recurrent hoarseness, stridor, and progressive respiratory distress. DIAGNOSES: The diagnostic evaluations included laboratory studies and imaging examinations, and imaging revealed a large RPA causing significant tracheal compression and pneumonia. INTERVENTIONS: Emergency management included intubation, mechanical ventilation, broad-spectrum antibiotics, and surgical drainage. OUTCOMES: Surgical drainage and targeted antibiotic therapy resolved inflammation. LESSONS: This novel case of delayed RPA after endoscopic foreign-body removal emphasizes the need for postoperative imaging, urgent surgical intervention, and enhanced caregiver education to prevent infant complications.