gms | German Medical Science

82nd Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

01.06. - 05.06.2011, Freiburg

To operate or not to operate

Meeting Abstract

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Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie. 82. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie. Freiburg i. Br., 01.-05.06.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11hnod737

doi: 10.3205/11hnod737, urn:nbn:de:0183-11hnod7376

Published: April 19, 2011

© 2011 Bardanis.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Introduction – Objective: Though not long ago the management of choice of upper aerodigestive tract perforations was the surgical one [1], currently the nonoperative management is also advocated [2], [3]. This study aims at presenting a case report of pneumopericardium combined with pneumomediastinum.

Case report: A 27 year-old man visited the outpatient ward of our hospital suffering from sore throat and chest pain after diving. Neck crepitance was palpated, while in indirect laryngoscopy a tiny laceration was observed subglottically. In the plain X-ray films air was observed in most areas of the neck, in mediastinum and in pericardium. Pneumothorax was not observed. The patient was administered high concentration of oxygen plus antibiotics intravenously. No longer than six days later without any surgical intervention all findings disappeared.

Instead of conclusion: A surgeon is a doctor who knows how to operate. A good surgeon is one who knows when to operate. The best surgeon is the one who knows when not to operate.


Shockley WW, Tate JL, Stucker FJ. Management of perforations of the hypopharynx and cervical esophagus. Laryngoscope. 1985;95(8):939-41. DOI: 10.1288/00005537-198508000-00011 External link
Dolgin SR, Wykoff TW, Kumar NR, Maniglia AJ. Conservative medical management of traumatic pharyngoesophageal perforations. Ann Otol Rhinol Laryngol. 1992;101(3):209-15.
Goudy SL, Miller FB, Bumpous JM. Neck crepitance: Evaluation and management of suspected upper aerodigestive tract injury. Laryngoscope. 2002;112(5):791-5. DOI: 10.1097/00005537-200205000-00005 External link