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Hypopharyngeal perforation caused by blunt trauma during consensual fellatio: an expectant management approach
  1. Edward Noon and
  2. Emma Stapleton
  1. Otolaryngology Department, Manchester Royal Infirmary, Manchester, UK
  1. Correspondence to Dr Edward Noon; edward.noon{at}


Perforation of the pharynx is a rare occurrence but has the potential to cause mediastinitis and has an attendant mortality risk. Though numerous mechanisms have been described, we report a unique case of a young woman who presented with a sore throat, odynophagia and subcutaneous emphysema, a short time after performing fellatio. A contrast swallow confirmed hypopharyngeal perforation. She was managed expectantly with nasogastric feeding and empirical antibiotics. The perforation took 4 weeks to heal, but there were no residual swallowing problems at 3-month follow-up. We will explore the incidence and causes of pharyngeal perforation and discuss the options for and risks of surgical repair. This case highlights that non-surgical management of such injuries can be both safe and feasible, and reinforces the importance of ensuring confidentiality and the need for vigilance regarding potential non-consensual injury.

  • ear
  • nose and throat/otolaryngology
  • pneumomediastinum
  • sexual health

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  • Contributors EN drafted the article and contributed to its conception. ES edited the article and contributed to its conception.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.