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World Journal of Surgery

, Volume 14, Issue 3, pp 400–405 | Cite as

Piriform sinus fistula: An underlying abnormality common in patients with acute suppurative thyroiditis

  • Akira Miyauchi
  • Fumio Matsuzuka
  • Kanji Kuma
  • Shin-ichiro Takai
International Association of Endocrine Surgeons—Manuscripts Presented at the 33rd World Congress of the International Society of Surgery

Abstract

We have previously reported that an internal fistula (piriform sinus fistula) was the apparent route of infection in 15 patients with acute suppurative thyroiditis (AST). Here, we describe 43 patients with AST, most of whom had a demonstrable fistula.

The characteristic clinical features included: onset in infancy or childhood in 74% of cases, a left-sided predominance of involvement (40∶3), and frequent recurrence. Twenty-nine patients had had several previous episodes of AST. The fistula was demonstrable in 38 of 42 patients examined by barium meal. Twenty-seven patients underwent fistulectomy. Six of 16 patients who declined fistulectomy had recurrences and 2 of them underwent surgery thereafter. None of 29 patients who had fistulectomy developed recurrences, except for 2 patients in whom the fistula could not be removed completely. The fistula ended medial or lateral to the thyroid lobe, attached to or entered the lobe in 6, 3, 6, and 12 cases, respectively. The thyroid specimens showed several features of inflammatory change.

Thus, we concluded that the piriform sinus fistula is the most common underlying abnormality in patients with AST. Recurrence of inflammation can be prevented by complete fistulectomy.

Keywords

Barium Thyroiditis Inflammatory Change Previous Episode Thyroid Lobe 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Nous avons déjà postulé que la voie apparente d'infection chez 15 patients ayant une thyroïdite aiguë suppurée (TAS) était une fistula interne (fistule sinusale piriforme). Nous décrivons ici 43 patients ayant une TAS, la plupart avec une fistule évidente.

Les caractéristiques cliniques étaient: début dans l'enfance pour 74% des cas, prédominance gauche (40∶3), et récidives fréquentes. Vingt-neuf patients ont déjà eu plusieurs épisodes de TAS. La fistule était visible par un transit baryté chez 38 des 42 patients ayant eu cet examen. Vingt-sept patients ont eu une fistulectomie. Six des 16 patients qui ont refusé la fistulectomie ont récidivé et 2 d'entre eux ont eu par la suite besoin d'une chirurgie. Aucun des 29 patients qui ont eu une fistulectomie n'a récidivé, sauf 2 patients chez qui on n'a pu enlever complètement la fistule. La localisation de la terminaison de la fistule était variable: sur la ligne médiane dans 6 cas, sur un bord latéral du lobe thyroïdien dans 3 cas, attachéé au lobe dans 6 cas, et entrant dans le lobe dans 12 cas. Les pièces d'exérèse thyroïdienne étaient inflammatoires.

Nous concluons donc que la fistule sinusale piriforme est l'anomalie principale de la TAS. La récidive de l'inflammation peut être évitée par une fistulectomie complète.

Resumen

Hemos reportado previamente que una fistula interna (fístula del seno piriforme) fue la causa aparente de infección en 15 pacientes con tiroiditis supurativa aguda (TSA). Sin embargo, en el presente artículo informamos 43 pacientes con TSA, la mayoría de los cuales tenía una fístula demostrable.

Las características clínicas incluyen: comienzo en la infancia o en la niñez en el 74% de los casos, mayor prevalencia de la lesión sobre el lado izquierdo (40∶3), y recurrencia frecuente. Veintinueve pacientes habían padecido varios episodios de TSA; la fístula fue demostrable en 38 de 42 pacientes examinados con bario administrado por vía oral. Veintisiete pacientes fueron sometidos a fistulectomía. Seis de 16 pacientes que rehusaron fistulectomía presentaron recurrencias y 2 de ellos fueron operados más tarde. Ninguno de 29 pacientes sometidos a fistulectomía desarrolló recurrencias, excepto 2 pacientes en quienes la fístula no pudo ser totalmente resecada. La fístula terminaba en la región medial al lóbulo tiroideo en 6 casos, en la región lateral en 3, aparecía ligada al lóbulo en 6 o entraba al lóbulo en 12. Los especimenes de glándula tiroides demostraron características de cambios inflamatorios.

Nuestra conclusión es que las fístulas del seno piriforme son la anormalidad etiológica más frecuente en pacientes con TSA. La recurrencia del proceso inflamatorio puede ser prevenida mediante la fistulectomía total.

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References

  1. 1.
    Hazard, J.B.: Thyroiditis. A review. Am. J. Clin. Pathol.25:289, 1955Google Scholar
  2. 2.
    Hawbaker, E.L.: Thyroid abscess. Am. Surg.37:290, 1971Google Scholar
  3. 3.
    Saito, S., Katakai, S.: Three cases of acute suppurative thyroiditis. Gumma J. Med. Sci.13:61, 1964Google Scholar
  4. 4.
    Miyauchi, A., Takai, S., Kosaki, G., Matsuzuka, F., Kuma, K.: A report of 7 cases of anterior neck abscess with a hypopharyngeal fistula presenting clinical features of acute suppurative thyroiditis. Proc. 11th Ann. Mtg. Jpn. Soc. Thyroid Surg., 1978, p. 24Google Scholar
  5. 5.
    Takai, S., Miyauchi, A., Matsuzuka, F., Kuma, K., Kosaki, G.: Internal fistula as a route of infection in acute suppurative thyroiditis. Lancet1:751, 1979Google Scholar
  6. 6.
    Miyauchi, A., Matsuzuka, F., Takai, S., Uematsu, M., Kobayashi, I., Shinya, S., Shiozaki, H., Takatsuka, Y., Kuma, K., Kosaki, G.: Pyriform-sinus fistula as a cause of acute suppurative thyroiditis. J. Jpn. Surg. Soc.80:948, 1979Google Scholar
  7. 7.
    Miyauchi, A., Matsuzuka, F., Takai, S., Kuma, K., Kosaki, G.: Piriform sinus fistula. A route of infection in acute suppurative thyroiditis. Arch. Surg.116:66, 1981Google Scholar
  8. 8.
    Taylor, Jr., W.E., Myer, III, C.M., Hays, L.L., Cotton, R.T.: Acute suppurative thyroiditis in children. Laryngoscope92:1269, 1982Google Scholar
  9. 9.
    Miller, D., Hill, J.L., Sun, C., O'Brien, D.S., Haller, Jr., J.A.: The diagnosis and management of pyriform sinus fistulae in infants and young children. J. Pediatr. Surg.18:377, 1983Google Scholar
  10. 10.
    Hirata, A., Saito, S., Tsuchida, Y., Hazama, H., Iwanaka, T., Shima, K., Hori, T.: Surgical management of piriform sinus fistula. Am. Surg.50:454, 1984Google Scholar
  11. 11.
    Kodama, T., Ito, Y., Obara, T., Fujimoto, Y.: Acute suppurative thyroiditis in appearance of unusual neck mass. Endocrinol. Japon.34:427, 1987Google Scholar
  12. 12.
    Burge, D., Middleton, A.: Persistent pharyngeal pouch derivatives in the neonate. J. Pediatr. Surg.18:230, 1983Google Scholar
  13. 13.
    Kaneko, G., Miyakawa, M., Sugenoya, A., Senga, O., Kobayashi, M., Hanamura, N., Yokozawa, T., Sode, Y., Ishizaka, K., Iida, F., Shirota, H., Makiuchi, M.: Acute suppurative thyroiditis resulting from infection through the piriform sinus fistula. Report of 6 cases and clinical studies on the surgical treatment. J. Jpn. Soc. Clin. Surg.45:590, 1984Google Scholar
  14. 14.
    Raven, R.W.: Pouches of the pharynx and esophagus with special reference to the embryological and morphological aspects. Br. J. Surg.21:235, 1933Google Scholar
  15. 15.
    Moore, K.L.: The Developing Human, 3rd edition, Philadelphia, W.B. Saunders, 1982, p. 187Google Scholar
  16. 16.
    English, J.S.C., Al-Hussani, A.: Recurrent suppurative thyroiditis due to pyriform fossa-thyroid fistula. J. Laryngol. Otol.97:557, 1983Google Scholar
  17. 17.
    Mo-suwan, L.: Acute suppurative thyroiditis in children; A case report. J. Med. Assoc. Thailand67:570, 1984Google Scholar
  18. 18.
    Tovi, F., Gatot, A., Bar-Ziv, J., Yanay, I.: Recurrent suppurative thyroiditis due to fourth branchial pouch sinus. Int. J. Pediatr. Otorhinolaryngol.9:89, 1985Google Scholar
  19. 19.
    Schlamp, D., Kruse, K., Naujoks, J.H.: Congenital pyriform fossa-thyroid fistula causing recurrent suppurative thyroiditis. Monatsschr. Kinderheilkd.134:475, 1986Google Scholar
  20. 20.
    Goudreau, E., Comtois, R., Bayardelle, P., Beauregard, H., Larochelle, D.: Capnocytophaga ochracea and group F Beta-hemolytic streptococcus suppurative thyroiditis. J. Otolaryngol.15:59, 1986Google Scholar

Copyright information

© Société Internationale de Chirurgie 1990

Authors and Affiliations

  • Akira Miyauchi
    • 1
    • 2
    • 3
  • Fumio Matsuzuka
    • 1
    • 2
    • 3
  • Kanji Kuma
    • 1
    • 2
    • 3
  • Shin-ichiro Takai
    • 1
    • 2
    • 3
  1. 1.Second Department of SurgeryKagawa Medical SchoolKagawaJapan
  2. 2.Kuma HospitalKobe
  3. 3.Second Department of SurgeryOsaka University Medical SchoolOsakaJapan

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