J Korean Soc Traumatol.  2012 Dec;25(4):278-282.

Esophageal Fistula Related to Anterior Cervical Spine Surgery after Severe Cervical Trauma

Affiliations
  • 1Department of Neurosurgery, College of Medicine, Inje University Busan Paik Hospital, Busan, Korea. shpaeng@empas.com

Abstract

An esophageal perforation following anterior cervical fusion is rare. Early development of an esophageal perforation after anterior cervical fusion is usually due to iatrogenic injury from retraction, injury associated with the original traumatic incident, improperly placed instruments or a bone graft. A 31-year-old man had a cervical dislocation and spinal cord injury because of severe cervical trauma after a traffic accident. He was quadriplegic and had no feeling below T4 dermatome. Anterior decompression of the cervical spine and anterior fusion with mesh with autobone were performed. An esophagocutaneous fistula occurred 7 days after anterior cervical surgery. A second anterior surgery was done because of pus drainage. The mesh was changed with an iliac bone graft, and the esophagocutaneous fistula site was primary repaired, but pus continued to drain. Conservative treatment, which consisted of wound drainage and intravenous administration of antibiotics, was tried, but was unsuccessful. After all, we removed the plate and screws, but did not removed the iliac bone graft, We closed the esophageal fistula, and transposed the sternocleidomastoid muscle flap to the interspace between the esophagus and the cervical spine. The wound to the esophagus was well repaired. In conclusion, precautionary measures are needed to avoid the complication, and adequate treatment is necessary to resolve those complications when they occur.

Keyword

Esophagocutaneous fistula; Anterior cervical fusion

MeSH Terms

Accidents, Traffic
Administration, Intravenous
Anti-Bacterial Agents
Decompression
Dislocations
Drainage
Esophageal Fistula
Esophageal Perforation
Esophagus
Fistula
Muscles
Spinal Cord Injuries
Spine
Suppuration
Transplants
Anti-Bacterial Agents
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