Delayed Presentation of Esophageal Perforation Following Cervical Surgery · 2018-04-05 · of...
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Remedy Publications LLC., | http://clinicsinsurgery.com/ Clinics in Surgery 2018 | Volume 3 | Article 1945 1 Delayed Presentation of Esophageal Perforation Following Cervical Surgery OPEN ACCESS *Correspondence: William C Welch, Department of Neurosurgery, University of Pennsylvania Health System, USA, E-mail: [email protected]. edu Received Date: 01 Mar 2018 Accepted Date: 12 Mar 2018 Published Date: 20 Mar 2018 Citation: Yang AI, McShane BJ, Kearney JA, Welch WC. Delayed Presentation of Esophageal Perforation Following Cervical Surgery. Clin Surg. 2018; 3: 1945. Copyright © 2018 Welch WC. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Clinical Image Published: 20 Mar, 2018 Andrew I Yang 1 , Brendan J McShane 1 , James A Kearney 2 , William C Welch 1 * 1 Department of Neurosurgery, University of Pennsylvania Health System, USA 2 Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania Health System, USA Clinical Image is is a 67-year-old female with a history of anterior C4-5 corpectomy with placement of vertebrectomy strut, C3-6 anterior fusion with plate, C3-6 laminectomy and posterior fusion for cervical stenosis with instability, who presented 2 years later with one day of dysphagia. Five months prior, she was diagnosed with pharyngitis, which had resolved with antibiotics. Barium swallow study at the time was negative for a leak. On current admission, CT and MRI were non-specific, demonstrating prevertebral edema. Bedside endoscopy did not reveal an esophageal injury. e patient was taken for removal of anterior hardware given her prior infection. ere was no intra- operative evidence of esophageal perforation on visual inspection and aſter esophageal injection with methylene blue. Re-instrumentation was not necessary as bony fusion was satisfactory. e patient was extubated on post-operative day (POD) 3, at which time barium swallow showed an esophageal defect at the site of the removed hardware (Figure 1). e patient was taken back for primary repair of the defect, reinforced with a rotational sternocleidomastoid muscle flap. A tracheostomy was performed given proximity of the repair to the larynx. e tracheostomy was removed on POD6, with repeat barium swallow showing no further evidence of leak. e patient tolerated oral intake on POD7, and she was discharged home uneventfully on POD9. Figure 1: Barium swallow study following negative surgical exploration and removal of anterior hardware shows extravasation of contrast from the cervical esophagus, tracking posteriorly into the prevertebral space.
Transcript of Delayed Presentation of Esophageal Perforation Following Cervical Surgery · 2018-04-05 · of...
Remedy Publications LLC., | http://clinicsinsurgery.com/
Clinics in Surgery
2018 | Volume 3 | Article 19451
Delayed Presentation of Esophageal Perforation Following Cervical Surgery
OPEN ACCESS
*Correspondence:William C Welch, Department of Neurosurgery, University of
Pennsylvania Health System, USA,E-mail: [email protected].
eduReceived Date: 01 Mar 2018Accepted Date: 12 Mar 2018Published Date: 20 Mar 2018
Citation: Yang AI, McShane BJ, Kearney JA, Welch WC. Delayed Presentation of
Esophageal Perforation Following Cervical Surgery. Clin Surg. 2018; 3:
1945.
Copyright © 2018 Welch WC. This is an open access article distributed under
the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work
is properly cited.
Clinical ImagePublished: 20 Mar, 2018
Andrew I Yang1, Brendan J McShane1, James A Kearney2, William C Welch1*1Department of Neurosurgery, University of Pennsylvania Health System, USA
2Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania Health System, USA
Clinical ImageThis is a 67-year-old female with a history of anterior C4-5 corpectomy with placement of
vertebrectomy strut, C3-6 anterior fusion with plate, C3-6 laminectomy and posterior fusion for cervical stenosis with instability, who presented 2 years later with one day of dysphagia. Five months prior, she was diagnosed with pharyngitis, which had resolved with antibiotics. Barium swallow study at the time was negative for a leak. On current admission, CT and MRI were non-specific, demonstrating prevertebral edema. Bedside endoscopy did not reveal an esophageal injury. The patient was taken for removal of anterior hardware given her prior infection. There was no intra-operative evidence of esophageal perforation on visual inspection and after esophageal injection with methylene blue. Re-instrumentation was not necessary as bony fusion was satisfactory. The patient was extubated on post-operative day (POD) 3, at which time barium swallow showed an esophageal defect at the site of the removed hardware (Figure 1). The patient was taken back for primary repair of the defect, reinforced with a rotational sternocleidomastoid muscle flap. A tracheostomy was performed given proximity of the repair to the larynx. The tracheostomy was removed on POD6, with repeat barium swallow showing no further evidence of leak. The patient tolerated oral intake on POD7, and she was discharged home uneventfully on POD9.
Figure 1: Barium swallow study following negative surgical exploration and removal of anterior hardware shows extravasation of contrast from the cervical esophagus, tracking posteriorly into the prevertebral space.
