Hospital: Hospital Universitario y Politécnico La Fe.
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Aut@r o Autores: M. Barreda-Solana, P. Estellés-Lerga, G. Cordon, A. Picado-Bermúdez, A. Oprisan.,
Presentación:
76-year-old male with history of C7 fracture, treated with anterior cervical arthrodesis. Two weeks after surgery the patient had persistent dysphagia. A CT of the neck was performed, showing that the posterior wall of the esophagus was penetrated by the screws of the arthrodesis, with their distal ends in the esophageal lumen. A small air-fluid collection in the lateral region of the hypopharynx was also observed. Surgery was performed, the arthrodesis material was removed and the esophageal perforation was repaired. The patient required a second surgery due to the presence of an esophageal-cutaneous fistula. The patient had a favorable evolution with closure of the fistula, no dysphagia and returned to normal diet.
Discusión:
Anterior cervical arthrodesis is the treatment of choice for unstable cervical fractures. 12% of patients undergoing this type of surgery have dysphagia, usually mild and transient due to edema secondary to esophageal manipulation (1). Esophageal perforation is a rare but serious complication, with an incidence of less than 1%. It usually presents intra-surgically or in the early postoperative period, secondary to manipulation or by bone splinters that lacerate the esophageal walls. Less frequently it has a late presentation secondary to rupture or displacement of the surgical material, which generates erosion / necrosis of the esophageal walls. This complication should be suspected in patients with history of anterior cervical arthrodesis and persistent dysphagia, collections, cervical fistulas, or mediastinitis.
Conclusión:
Anterior cervical arthrodesis is the treatment of choice for unstable cervical fractures. 12% of patients undergoing this type of surgery have dysphagia, usually mild and transient due to edema secondary to esophageal manipulation (1). Esophageal perforation is a rare but serious complication, with an incidence of less than 1%. It usually presents intra-surgically or in the early postoperative period, secondary to manipulation or by bone splinters that lacerate the esophageal walls. Less frequently it has a late presentation secondary to rupture or displacement of the surgical material, which generates erosion / necrosis of the esophageal walls. This complication should be suspected in patients with history of anterior cervical arthrodesis and persistent dysphagia, collections, cervical fistulas, or mediastinitis.
Bibliografía:
– Baron EM, Soliman AM, Gaughan JP, et al. Dysphagia, hoarseness, and unilateral true vocal fold motion impairment following anterior cervical discectomy and fusion. Ann Otol Rhinol Laryngol 2003, 112:921–6. – Harman F, Kaptanoglu E, Hasturk AE. Esophag