Delayed Esophageal Perforation after Cervical Spine Plating
A 43-year-old man was admitted to our institute with a 3-month history of dysphagia and neck pain with swelling. He was paraplegic due to a C6-7 fracture and dislocation and has been operated on 8 years previously. Initial surgical treatment included anterior corpectomy of C7 and anterior iliac crest graft placement using a plate and screws. Hematological studies including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were normal. A simple lateral radiograph and a computed tomography scan showed partial anterior migration of the lower screw. A hydro-soluble contrast swallow image confirmed esophageal perforation (). The protruding screw was observed during emergent esophagoscopy (). Surgery was scheduled for removal of offending screw. The loose screw was removed and esophageal perforation was found during surgery and repaired directly by a cardiovascular team(). The patient was fed using a nasogastric tube for 3 weeks and subsequently oral feeding was gradually resumed. Further progress was favorable, and a contrast study performed at 3 weeks postoperatively showed no evidence of fistula.