THE BLEEDING MIGRATION: ESOPHAGEAL INJURY FROM CERVICAL HARDWARE

Abstract

SESSION TITLE: Critical Gastrointestinal Case ReportsSESSION TYPE: Rapid Fire Case ReportsPRESENTED ON: 10/18/2022 12:25 pm - 01:25 pmINTRODUCTION: Esophageal perforation is an infrequent but serious complication of anterior cervical spinal surgery. The median time of diagnosis of this feared complication is generally delayed, greater than two years, as reported in the literature [1]. Early recognition is paramount in preventing morbidity and, in some cases, mortality.CASE PRESENTATION: A 64-year-old male with a history of metastatic renal cell carcinoma status post chemoradiotherapy, radiation induce esophagitis, and cervical spine metastasis status post anterior cervical corpectomy and fusion was brought into the hospital by his wife when she noticed blood in Yankauer suction canister at home. The patient stated that he uses the suction device due to difficulty managing oral secretions and noticed blood-tinged secretions for a week that gradually worsened. On arrival, he was normotensive with a heart rate of 89 bpm and oxygen saturation of 95% on room air. Physical examination, Hemogram, and chemistry were unremarkable. The coagulation profile was within normal limits as well. CT chest and abdomen with intravenous contrast did not identify any pathology to explain his presentation. So, he underwent EGD, which showed a metallic foreign object protruding through the posterior wall of the proximal esophagus. Due to his previous history of cervical spine fusion with metallic hardware, there was suspicion of hardware migration. So he underwent CT cervical spine, which confirmed the fear, and he subsequently underwent removal of hardware and primary repair with a resolution of his symptoms.DISCUSSION: The incidence of esophageal perforation after the anterior cervical spine surgery is 0.2%-1.15%. A systemic review by Halani et al. of 153 patients who underwent anterior spinal surgery and sustained some forms of esophageal perforation showed that this serious complication presents in a delayed fashion in the majority of instances. So the physicians should look out for the signs and symptoms of dysphagia or odynophagia that may be the early symptom of the said complication [2].CONCLUSIONS: Esophageal perforation can occur due to chronic compression and erosion from the hardware. A high degree of suspicion for the complication mentioned above is required to diagnose and provide timely multi-disciplinary care to prevent disastrous outcomes.Reference #1: 1. A. Marquez-Lara, S. V. Nandyala, H. Hassanzadeh, M. Noureldin, S. Sankaranarayanan, and K. Singh, "Sentinel events in cervical spine surgery," The Spine Journal, vol. 39, no. 9, pp. 715–720, 2014.Reference #2: 2. S. H. Halani, G. R. Baum, J. P. Riley et al., "Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature," Journal of Neurosurgery: Spine, vol. 25, no. 3, pp. 285–291, 2016.DISCLOSURES: No relevant relationships by Yi-Ju ChenNo relevant relationships by Richa NeupaneNo relevant relationships by Rajan PathakNo relevant relationships by Hafiz Muhammad Siddique QurashiNo relevant relationships by Navitha Ramesh SESSION TITLE: Critical Gastrointestinal Case Reports SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Esophageal perforation is an infrequent but serious complication of anterior cervical spinal surgery. The median time of diagnosis of this feared complication is generally delayed, greater than two years, as reported in the literature [1]. Early recognition is paramount in preventing morbidity and, in some cases, mortality. CASE PRESENTATION: A 64-year-old male with a history of metastatic renal cell carcinoma status post chemoradiotherapy, radiation induce esophagitis, and cervical spine metastasis status post anterior cervical corpectomy and fusion was brought into the hospital by his wife when she noticed blood in Yankauer suction canister at home. The patient stated that he uses the suction device due to difficulty managing oral secretions and noticed blood-tinged secretions for a week that gradually worsened. On arrival, he was normotensive with a heart rate of 89 bpm and oxygen saturation of 95% on room air. Physical examination, Hemogram, and chemistry were unremarkable. The coagulation profile was within normal limits as well. CT chest and abdomen with intravenous contrast did not identify any pathology to explain his presentation. So, he underwent EGD, which showed a metallic foreign object protruding through the posterior wall of the proximal esophagus. Due to his previous history of cervical spine fusion with metallic hardware, there was suspicion of hardware migration. So he underwent CT cervical spine, which confirmed the fear, and he subsequently underwent removal of hardware and primary repair with a resolution of his symptoms. DISCUSSION: The incidence of esophageal perforation after the anterior cervical spine surgery is 0.2%-1.15%. A systemic review by Halani et al. of 153 patients who underwent anterior spinal surgery and sustained some forms of esophageal perforation showed that this serious complication presents in a delayed fashion in the majority of instances. So the physicians should look out for the signs and symptoms of dysphagia or odynophagia that may be the early symptom of the said complication [2]. CONCLUSIONS: Esophageal perforation can occur due to chronic compression and erosion from the hardware. A high degree of suspicion for the complication mentioned above is required to diagnose and provide timely multi-disciplinary care to prevent disastrous outcomes. Reference #1: 1. A. Marquez-Lara, S. V. Nandyala, H. Hassanzadeh, M. Noureldin, S. Sankaranarayanan, and K. Singh, "Sentinel events in cervical spine surgery," The Spine Journal, vol. 39, no. 9, pp. 715–720, 2014. Reference #2: 2. S. H. Halani, G. R. Baum, J. P. Riley et al., "Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature," Journal of Neurosurgery: Spine, vol. 25, no. 3, pp. 285–291, 2016. DISCLOSURES: No relevant relationships by Yi-Ju Chen No relevant relationships by Richa Neupane No relevant relationships by Rajan Pathak No relevant relationships by Hafiz Muhammad Siddique Qurashi No relevant relationships by Navitha Ramesh