Alec W Gibson1, Theodore A Gobillot1, David I Bass2, Zilvinas Zakarevicius3, Zain H Rizvi4, Ali C Ravanpay5. 1. School of Medicine, University of Washington, Seattle, Washington, USA. 2. Department of Neurological Surgery, University of Washington, Seattle, Washington, USA. 3. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA; Neurosurgery, VA Puget Sound Health Care System, Seattle, Washington, USA. 4. Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA; Neurosurgery, VA Puget Sound Health Care System, Seattle, Washington, USA. 5. Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Neurosurgery, VA Puget Sound Health Care System, Seattle, Washington, USA. Electronic address: respub5@uw.edu.
Abstract
BACKGROUND: Esophageal perforation represents a rare but potentially life-threatening complication of an anterior cervical diskectomy and fusion (ACDF). Delayed presentations of esophageal perforation more than 10 years following surgery are exceedingly rare and difficult to diagnose. Here, we discuss the case of an 80-year-old man who presented to the emergency department with progressive dysphagia 15 years after his ACDF. CASE DESCRIPTION: While prior outpatient workup was suggestive of a diverticulum, there was no evidence of esophageal perforation. Progressive symptoms and repeat imaging on admission were suggestive of retropharyngeal phlegmon. Operative esophagoscopy revealed that the spinal hardware had eroded through the posterior wall of the esophagus, creating a traction diverticulum. The hardware was removed, and the esophageal perforation was closed primarily and buttressed with vascularized tissue from a supraclavicular artery island fascial flap. CONCLUSIONS: This case emphasizes the importance of considering an esophageal perforation in patients who present with dysphagia at any interval following an ACDF, even in the extremely delayed setting. Furthermore, this is the first report, to the best of our knowledge, using a supraclavicular artery island fascial flap to reconstruct an esophageal perforation following an ACDF, and we introduce a novel strategy for managing these complicated injuries.
BACKGROUND: Esophageal perforation represents a rare but potentially life-threatening complication of an anterior cervical diskectomy and fusion (ACDF). Delayed presentations of esophageal perforation more than 10 years following surgery are exceedingly rare and difficult to diagnose. Here, we discuss the case of an 80-year-old man who presented to the emergency department with progressive dysphagia 15 years after his ACDF. CASE DESCRIPTION: While prior outpatient workup was suggestive of a diverticulum, there was no evidence of esophageal perforation. Progressive symptoms and repeat imaging on admission were suggestive of retropharyngeal phlegmon. Operative esophagoscopy revealed that the spinal hardware had eroded through the posterior wall of the esophagus, creating a traction diverticulum. The hardware was removed, and the esophageal perforation was closed primarily and buttressed with vascularized tissue from a supraclavicular artery island fascial flap. CONCLUSIONS: This case emphasizes the importance of considering an esophageal perforation in patients who present with dysphagia at any interval following an ACDF, even in the extremely delayed setting. Furthermore, this is the first report, to the best of our knowledge, using a supraclavicular artery island fascial flap to reconstruct an esophageal perforation following an ACDF, and we introduce a novel strategy for managing these complicated injuries.
Authors: Matthew Helton; James Reed Gardner; Quinn Dunlap; T Glenn Pait; Jumin Sunde; Emre Vural; Mauricio Alejandro Moreno Journal: OTO Open Date: 2021-07-20