Esophageal Fistula following Anterior Cervical Discectomy and Fusion in Traumatic Cervical Injury Cases: A Review

Abstract Background Esophageal fistula is a very rare complication associated with anterior approaches to the cervical spine. Timely diagnosis and early intervention are associated with favorable outcomes. There is a dilemma in the literature for its optimal management. In this review article, we will discuss the management dilemmas in patients with esophageal perforation along with an illustrative case. Material and Methods A 24-year-old male patient operated for C5–6 fracture dislocation, presented with esophageal fistula 1 month after surgery. Investigations were done to localize the site of fistula but definitive site of leak could not be identified. Patient was counselled regarding possible surgical intervention; however, patient was opted for conservative treatment. Conclusion Esophageal fistula is a very rare occurrence. Because of varied clinical presentation and frequent delay in diagnosis, a very high index of suspicion should always be kept in mind while evaluating a patient postoperatively for dysphagia. Timely diagnosis and early intervention are key to a successful outcome.

[1]  Eric N Appelbaum,et al.  Esophageal Perforation due to Anterior Cervical Spine Hardware Placement: Case Series , 2019, International journal of otolaryngology.

[2]  P. Santillán-Doherty,et al.  Successive complications after anterior cervical fixation: pharyngoesophageal diverticulum, fistulization, and cervical spondylitis by Streptococcus milleri – case report and literature review , 2019, Journal of Medical Case Reports.

[3]  K. Fountas,et al.  Anterior cervical spine surgery-associated complications in a retrospective case-control study. , 2017, Journal of spine surgery.

[4]  K. Mukherjee,et al.  Two Cases of Esophageal Injury Following Anterior Cervical Discectomy and Fusion: One Overt and One Covert , 2017, Annals of Neurosciences.

[5]  Zorica Buser,et al.  Treatment for early postoperative esophageal fistula complicated with anterior cervical surgery , 2017, Journal of orthopaedic surgery.

[6]  W. Yuan,et al.  Esophageal Perforation in a Cervical Fracture Patient With Progressed Ankylosing Spondylitis: Case Report and Review of the Literature , 2016, Spine.

[7]  Sameer H. Halani,et al.  Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature. , 2016, Journal of neurosurgery. Spine.

[8]  Sang-Bok Lee,et al.  Delayed Esophagus Perforation after Anterior Cervical Spine Surgery , 2015, Korean journal of neurotrauma.

[9]  Majed Al-Mourgi Sternocleidomastoid flap for repair of pharyngocutaneous fistula following anterior cervical spine surgery , 2015 .

[10]  B. Iliescu,et al.  Rare complication of the cervical spine trauma--traumatic esophageal fistula: case report and review of the literature. , 2014, Revista medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi.

[11]  Víctor Rodrigo Paradells,et al.  Esophageal, pharyngeal and hemorrhagic complications occurring in anterior cervical surgery: Three illustrative cases , 2014, Surgical neurology international.

[12]  F. Vale,et al.  Otolaryngologic management of delayed pharyngoesophageal perforation following anterior cervical spine surgery , 2010, The Laryngoscope.

[13]  Juan S. Uribe,et al.  Management of delayed esophageal perforations after anterior cervical spinal surgery. , 2009, Journal of neurosurgery. Spine.

[14]  E. Ruffini,et al.  Successful surgical management of a delayed pharyngo-esophageal perforation after anterior cervical spine plating , 2008, European Spine Journal.

[15]  G. Chandra,et al.  Non malignant tracheo-esophageal fistula: Our experience , 2005 .

[16]  S. Lad,et al.  Pharyngeal perforation and spontaneous extrusion of the cervical graft with its fixation device: a late complication of C2-C3 fusion via anterior approach , 2001, Journal of Clinical Neuroscience.

[17]  C. Clark,et al.  Esophageal Perforation Following Anterior Cervical Spine Surgery , 1989, Spine.

[18]  S. Mattioli,et al.  Pharyngo-oesophageal perforation following anterior cervical discectomy and fusion: management and results† , 2017, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[19]  J. P. Johnson,et al.  Esophageal injury associated with anterior cervical spine surgery. , 2008, Surgical neurology.