Large Perforation of Hypopharynx Secondary to Anterior Cervical Approach : A Complicated Case
A 58-year-old male transferred to our emergency room (ER) complaining of painful swelling in the anterior cervical region. The patient underwent C3-4 discectomy and total disc replacement 3 days ago with the diagnosis of C3-4 disc herniation in local spine clinic. A physical examination identified painful edema in the surgical site of the anterior cervical region and necrotic skin tissue. Other findings included subcutaneous emphysema with crepitus in the area of the surgical site. His body temperature was 37.2℃ when he was transferred to ER. A hematological analysis demonstrated that his leukocyte count was 9670/mL, with an erythrocyte sedimentation tare of 70 mm/hr and a C-reactive protein of 19.9 mg/dL. Subcutaneous and mediastinal emphysema were identified by cervical computed tomography scans (). An esophagogram with gastrografin showed that a large amount of contrast medium had leaked into the right lateral cervical region (). Based on these findings, the patient was diagnosed with a perforation in the hypopharynx following the anterior cervical discectomy. As a result, an emergency surgery was performed to repair the perforation under general anesthesia. The operative findings included extensive soft tissue necrosis and abscess formation, both of which were removed and cultured. The perforated site was approximately 2 cm long and was found outside the pyriform sinus in the right hypopharynx (). The mucous membrane was sutured with Vicryl 3-0 in two layers from the outside. There was an attempt to reinforce the perforated part with the surrounding muscle, but severe inflammation prevented its use. Consequently, Tissel® was spread on the surgical site before the tube was inserted for drainage. On the 10th day after the operation, the drainage tube was removed. An esophagogram conducted on the 13th day after the operation showed no contrast leakage (). A liquid diet was permitted 15 days after the operation. Thereafter, the patient was transferred to the plastic surgery department of our institute to receive skin graft. A full-thickness skin graft was performed before the patient was discharged from the hospital. The patient was monitored for six months after the operation and showed no sign of complications.