Retropharyngeal and mediastinal abscess following adenoidectomy: A case report

Adenoidectomy is one of the most common surgical procedures performed in children. While generally considered safe, rare but serious complications may occur. We present the case of a 3-year-old girl who developed a retropharyngeal abscess extending to the mediastinum following adenoidectomy. The patient presented with a high fever of up to 40 °C, severe torticollis, and significant dysphagia three days after the procedure performed at another hospital. Clinical examination revealed marked neck tenderness. Laboratory tests showed leukocytosis and elevated C-reactive protein. Initial treatment with amoxicillin-clavulanic acid did not improve her condition. A contrast-enhanced CT scan of the neck and upper chest demonstrated a retropharyngeal edema that progressed to a well-defined abscess with extension to the superior mediastinum on follow-up imaging. The patient underwent a surgical cervical approach with drainage of the abscess and placement of drains. Following one week of intravenous antibiotic therapy, she was discharged in good condition. A follow-up MRI performed one month later was normal. This case highlights a rare but potentially life-threatening complication of adenoidectomy. Early recognition, appropriate imaging, and prompt management are crucial for favorable outcomes. Otolaryngologists should be aware of this uncommon complication and maintain a high index of suspicion when evaluating post-adenoidectomy patients with persistent fever, neck pain and torticollis.