Children with recurrent neck infections that form abscesses, especially in the left side of the thyroid area, need to be alerted to a disease – pear-shaped fossa fistula. Pearly fossa fistula is a specific type of congenital cervical gill fistula with an internal opening located in the pearly fossa of the esophagus. The disease occurs in childhood, more often between the ages of 2 and 6 years, mainly in the left side of the thyroid area, accounting for more than 90% of the incidence. The disease occurs with localized redness, swelling, heat, and pain in the thyroid area, which may be accompanied by fever and rapidly becomes an abscess within 3-5 days. The diagnosis requires a barium swallow after the infection is controlled, and a residual beak-like barium shadow can be seen at the level of the fifth cervical vertebra. In some patients, the fistula can be closed with adhesions after multiple infections and no infection occurs at a later stage. Patients who cannot heal spontaneously require surgical radical treatment to remove the fistula from the posterior border of the thyroid gland in the neck. The disease is highly susceptible to clinical misdiagnosis as a general neck abscess infection.