Pharyngoesophageal Perforation Research Articles

Iatrogenic pharyngoesophageal perforation in very low birth weight infants

Iatrogenic pharyngoesophageal perforation in very low birth weight infants

Clinical Features of iatrogenic Pharyngo-esophageal perforation in very low birth weight infants

BackgroundIatrogenic pharyngoesophageal perforation (IPEP) is one of the complications of gastric tube insertion and it tends to occur more frequently in premature infants. Although the frequency is significantly low, attention should be paid as it can lead to serious outcomes with high mortality. This study will help raise awareness with respect to early diagnosis, management, and prevention. MethodsWe performed a retrospective cohort study of all very low birth weight infants diagnosed with IPEP between 1993 and 2022. ResultsA total of 6 patients (0.27% of very low birth weight infants) with the diagnosis of IPEP were included. The median gestational age was 27 + 1 weeks (range 23+5–28 + 6 weeks), and the median birth weight was 823 g (range 630–1232 g). Symptoms included difficulty with gastric tube insertion, bloody secretions in the oral cavity, and increased oral secretions. X-rays revealed aberrant running of the gastric tube in all patients. In three cases, contrast studies demonstrated contrasted mediastinum tapering like a bead. Laryngoscope was used to view the perforation sites but this was not useful in the smallest patient. All patients were treated conservatively with antibiotics and survived. ConclusionsWhen inserting a gastric tube for premature infants, it is critical to remember that these infants are at risk of IPEP. In addition to a frontal X-ray, a lateral X-ray and contrast study may be useful for early diagnosis.

Four Cases of Delayed Pharyngo-esophageal Perforation Following Anterior Cervical Plate Fixation

Four Cases of Delayed Pharyngo-esophageal Perforation Following Anterior Cervical Plate Fixation

A Surgical Alternative in the Treatment of Hypopharyngeal Perforation

Summary:Pharyngo-esophageal perforation is a rare, life-threatening complication of anterior cervical discectomy and fusion surgery with an incidence estimated to be between 0.2 and 1.51%. Early diagnosis and appropriate treatment of this complication is the key to reduce morbidity and mortality, as the main prognostic factor is the interval between the onset of the fistula, diagnosis and treatment. Conservative management has shown encouraging results in small and localized defects, whereas surgical approaches using flaps are to be considered for most of the cases. However, there is no clear consensus on the first choice of treatment in esophageal perforation. This case report presents the use of a supra-clavicular fascio-cutaneous pedicled propeller flap as a patch combined to primary repair of a hypopharyngeal perforation, 10 years after anterior cervical spine arthrodesis.

Pharyngoesophageal Damage from Hardware Extrusion at an Average of 7.5 Years After Anterior Cervical Diskectomy and Fusion: A Case Series, Discussion of Risk Factors, and Guide for Management

We present a single-institution case series of patients who experienced pharyngoesophageal damage, specifically from extruded hardware occurring at an average of 7.5 years after anterior cervical diskectomy and fusion (ACDF). A retrospective chart review was conducted of patients who had undergone ACDF with subsequent delayed pharyngoesophageal perforation or erosion from extruded hardware ≥1 year after surgery. A discussion of the literature surrounding this complication, including risk factors and management, is also presented. Nine patients were identified (average age 58 years, 66.7% male) among a total of 4122 ACDF patients (incidence: 0.22%). Average time to injury was 7.5 years. Indications for initial ACDF were degenerative cervical disease (n= 7), ankylosing spondylitis (n= 1), and cervical fracture (n= 1). Eight patients had prior multilevel ACDF spanning 2 (n= 4), 3 (n= 1), or 4 levels (n= 2). Fusion levels for prior ACDF included C5-C7 (n= 3), C3-C7 (n= 2), C4-C7 (n= 1), C4-C6 (n= 1), C2-C5 (n= 1), and C6-C7 (n= 1). Pharyngoesophageal injuries included esophageal perforation (n= 3), pharyngeal perforation (n= 2), esophageal erosion (n= 3), and pharyngoesophageal erosion (n= 1). In most (n= 6) cases, the cause of pharyngoesophageal damage was due to ≥1 extruded screws. Dysphagia (n= 8) was the most common presenting symptom. For perforations (n= 5), 2 repairs used a rotational flap to reinforce a primary closure; the other 3 cases were repaired via primary closure. Pharyngoesophageal damage caused by extruded hardware may occur several years after ACDF. These delayed complications are difficult to predict. Proper screw placement may be the most important factor for minimizing the chances of this potentially devastating complication, particularly with multilevel constructs.

Pharyngo-Esophageal Perforation Following Anterior Cervical Spine Surgery: A Single Center Experience and a Systematic Review of the Literature.

Study Design:Case series and systematic review of the Literature.Objectives:Pharyngo-esophageal perforation (PEP) is a rare, life-threatening complication of anterior cervical spine surgery (ACSS). Best management of these patients remains poorly defined. The aim of this study is to present our experience with this entity and to perform a systematic Literature review to better clarify the appropriate treatment of these patients.Methods:Patients referred to our center for PEP following ACSS (January 2002-December 2018) were identified from our database. Moreover, an extensive review of the English Literature was conducted according to the 2009 PRISMA guidelines.Results:Twelve patients were referred to our Institution for PEP following ACSS. Indications for ACSS were trauma (n = 10), vertebral metastases (n = 1) and disc herniation (n = 1). All patients underwent hardware placement at the time of ACSS. There were 6 early and 6 delayed PEP. Surgical treatment was performed in 11 patients with total or partial removal of spine fixation devices, autologous bone graft insertion or plate/cage replacement, anatomical suture of the fistula and suture line reinforcement with myoplasty. Complete resolution of PEP was observed in 6 patients. Five patients experienced PEP persistence, requiring further surgical management in 2 cases. At a median follow-up of 18.8 months, all patients exhibited permanent resolution of the perforation.Conclusions:PEP following ACSS is a rare but dreadful complication. Partial or total removal of the fixation devices, direct suture of the esophageal defect and coverage with tissue flaps seems to be an effective surgical approach in these patients

Pharyngoesophageal perforation during introduction of an echoendoscope treated with a fully covered self-expandable metal stent.

Pharyngoesophageal perforation during introduction of an echoendoscope treated with a fully covered self-expandable metal stent.

A RARE CASE OF CERVICAL HARDWARE MIGRATION CAUSING ESOPHAGEAL PERFORATION

SESSION TITLE: Medical Student/Resident Procedures Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Esophageal perforation caused by migration of cervical hardware in the delayed setting is a rare but deadly complication of anterior cervical spine surgery (ACSS). Esophageal perforation is a known complication of ACSS, which accounts for more than 40% of documented cases. However only 0.2-1.5% of those cases happened in the delayed setting and the initial presentation can be atypical. The purpose of this report is to highlight the importance of promptly diagnosing these patients and moving forward with the appropriate management. CASE PRESENTATION: 32-year-old man with a PMH of C6 spinal cord injury 3 years prior with residual quadriplegia requiring anterior cervical discectomy and fusion (ACDF) of C6-T1 with C7 corpectomy and a tracheostomy. He presented with worsening abdominal pain. Imaging and colonoscopy were both normal so an EGD was performed which found an eroded foreign body in the lumen of the proximal esophagus. Neurosurgery was consulted and ordered CT imaging which confirmed our suspicion. A bronchoscopy was then done to evaluate his tracheostomy site which did not appear to have any effect on his airway nor were any fistulas observed. Despite the aforementioned findings the patient was clinically stable and denied any dysphagia, odynophagia, poor appetite, or irregular bowel movements. Patient is currently scheduled for cervical spine hardware revision. DISCUSSION: ACDF has been around since the 1950s, is well documented, and has an overall complication rate of 5%. That being said, surgical complications including perforation can be further subdivided into acute or delayed (>30 days post-op) and can range from local infection to mediastinitis and death. While most acute perforations during or after ACSS are iatrogenic, the majority of delayed perforations are from hardware failure (41%) which come from loosened or migrated screws/plates. Chronic erosion of hardware makes up 31% of cases and is thought to be caused by tissue ischemia from the prolonged pressure of cervical hardware, thus weakening the posterior esophageal wall leading to deadly complications. Esophageal perforation in this subset of patients can happen during ACSS or up to 11 years post-operatively in some studies. Obtaining a pertinent history is paramount in the settings of acute versus chronic esophageal perforations. An acute perforation would present with dysphagia and odynophagia (54%), fever (21%), and/or neck swelling (21%). Our case is atypical in that our patient was being worked up for something entirely different and denied any of the aforementioned signs and symptoms. CONCLUSIONS: Delayed esophageal erosions require a high level of suspicion as presenting signs and symptoms may be nonspecific. Operative interventions with revision of cervical spine surgery and myofascial repair are the standard of care for this condition with considerations being made for comorbidities and clinical circumstances. Reference #1: 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. Reference #2: 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 #3: D. Yin, X. Yang, Q. Huang et al., “Pharyngoesophageal perforation 3 years after anterior cervical spine surgery: a rare case report and literature review,” European Archives of Oto-Rhino-Laryngology, vol. 272, no. 8, pp. 2077–2082, 2015. DISCLOSURES: No relevant relationships by Zaid Ansari, source=Web Response No relevant relationships by MAYKEL IRANDOST, source=Web Response No relevant relationships by Tyler Putnam, source=Web Response No relevant relationships by Ali Saeed, source=Web Response

Fatal pharyngoesophageal perforation caused by extraction of duodenal mass

An 85-year-old woman with postprandial epigastric pain and weight loss was referred for EUS to evaluate a duodenal mass seen on CT. EGD revealed a pedunculated subepithelial mass in the duodenal bulb (A). EUS showed a 3-cm mixed solid and cystic mass in layer III and an avascular stalk (A, arrows). Given her symptoms and nondiagnostic EUS result, the mass was removed with a snare after the stalk was clipped. The mass was retrieved with a Roth net, and moderate resistance was noted during extraction through the upper esophageal sphincter.

2114 Pharyngo-esophageal Perforation During Endoscopic Ultrasound: Case Report and Literature Review

INTRODUCTION: EUS related serious complications such as luminal perforation, pancreatitis and bleeding are rare. We report a case of EUS-related pharyngo-esophageal perforation, successfully managed conservatively and brief literature review. CASE DESCRIPTION/METHODS: A 75-year-old male presented with elevated LFTs without jaundice. CA 19-9 was elevated (112 U/mL). CT revealed a double duct sign and a 3 cm pancreatic head mass (Figure 1). Decision was made to proceed with EUS with FNA. Diagnostic EGD noted no luminal esophageal narrowing. The linear array echoendoscope was inserted into the oropharynx but was difficult to pass into the esophagus secondary to cervical osteophytes. The gastroscope was reinserted into the esophagus. Minimal pharyngeal mucosal trauma was noted. A savary guidewire was passed into the stomach; the gastroscope was removed. The echoendoscope was backloaded onto the wire and reinsertion attempted. Despite gentle maneuvers and multiple attempts, resistance to passage was encountered, esophageal intubation was not possible; the echoendoscope was removed. Repeat EGD revealed a 2 cm deep mucosal tear extending from the posterior pharynx to the esophageal inlet without full-thickness perforation or significant bleeding (Figure 2). The gastroscope and the guidewire were removed and the procedure was terminated. Patient complained of throat pain, especially with swallows. CT showed pneumomediastinum and extraluminal air and edema adjacent to the right aspect of the pharynx & esophagus (Figure 3), consistent with a pharyngo-esophageal microperforation. Thoracic surgery was consulted, antibiotics started, patient kept NPO. The patient remained hemodynamically stable with improved pain and no need for surgical intervention, discharged home on post-procedure day 4. DISCUSSION: EUS is a safe procedure with complication rates comparable to EGD. The rate of esophageal perforation is very low, ranging from 0.03-0.04%. The treatment for pharyngo-esophageal perforation depends upon the degree, location, timing of diagnosis, hemodynamic status and clinical status of the patient. In a case series of 16 cervical esophageal perforations, 44% of patients had history of difficult intubation with endoscopic procedures. 81% were managed conservatively.1 Early recognition and timely management is critical for ensuring an excellent outcome with conservative management. JOURNAL/ajgast/04.03/00000434-201910001-02115/figure1/v/2023-08-15T171636Z/r/image-tiff JOURNAL/ajgast/04.03/00000434-201910001-02115/figure2/v/2023-08-15T171636Z/r/image-tiff JOURNAL/ajgast/04.03/00000434-201910001-02115/figure3/v/2023-08-15T171636Z/r/image-tiff

1703 Hematemesis: A Turn of the Screw

INTRODUCTION: Anterior cervical discectomy and fusion (ACDF) in combination with locking plates is considered the standard treatment for cervical spinal trauma, tumors and degenerative disc disease. We present a case of upper gastrointestinal bleed resulting from delayed pharyngoesophageal perforation due to loosened screw in the presence of normally positioned hardware. CASE DESCRIPTION/METHODS: A 43-year-old male with hypertension, bradycardia status post pacemaker, cervical stenosis status post C3 -C6 fusion 1 year prior came to the ER with chief complaint of throat and chest pain followed by one episode of hematemesis noticing a 2 cm screw in vomitus. Initial vitals showed T 36.4, HR 78, BP 139/94, RR 18, and SpO2 96% on RA. Cervical spine x-ray showed intact plate of cervical spine with missing screw. Patient was admitted to the ICU and gastroenterology was consulted. Gastrografin swallow study did not show extravasation of contrast and subsequent endoscopy showed extensive soft tissue swelling in the left hypopharynx without purulent exudate. Bedside fiberoptic laryngoscopy showed left pharyngeal posterior wall prominence extending from inferior to tonsil to tip of epiglottis with intact overlying mucosa. Head and neck surgeon recommended non-operative intervention, so the patient was started on broad spectrum antibiotics through the PICC line. He was started on clear liquid diet and advanced to full liquids. His blood count remained stable and he had no further hematemesis. Outpatient follow up showed satisfactory recovery. DISCUSSION: Pharyngoesophageal injuries following ACDF are rare with an incidence of <2%. Most perforations are identified in immediate or early postoperative period and result from iatrogenic injury during the procedure and carry high mortality rates. Early local symptoms include neck swelling, dysphagia, fever and subcutaneous emphysema leading to mediastinitis. Fistula formation, microcytic anemia and neck mass are the most common late presentations. Xray of the neck, contrast swallow studies and flexible endoscopy can help locate perforation. When conservative treatment fails or there is systemic involvement, this requires hardware removal, debridement and suture closure of the defect with or without sternocleidomastoid muscle, superior omohyoid muscle, or pertoralis major flap enforcement to reduce the risk of failure. Patients presenting with upper GI bleed, signs of neck infection, and history of cervical spine plating should be evaluated for hardware-related complications.

Pharyngo-esophageal Perforation Induced by Dental Implant Ingestion Immediately after Thoracic Surgery via Sternotomy: A Case Report

Pharyngo-esophageal Perforation Induced by Dental Implant Ingestion Immediately after Thoracic Surgery via Sternotomy: A Case Report

Esophageal Perforation due to Anterior Cervical Spine Hardware Placement: Case Series.

Context. This case series discusses surgical management of esophageal perforations that occurred following cervical spine hardware placement. Purpose. (1) Determine presenting symptoms of esophageal perforation after anterior cervical spine hardware placement. (2) Discuss surgical management of these resulting esophageal perforation complications. Design/Setting. Case series of six patients at a tertiary-care, academic medical center. Patient Sample. Six patients with pharyngoesophageal perforations following anterior cervical spine surgery (ACSS). Outcome Measures. Date of ACSS, indication for ACSS, level of hardware, location of esophageal or pharyngeal injury, symptoms at presentation, surgical intervention, type of reconstruction flap, wound culture flora, and antibiotic choice. Methods. A retrospective review of patients with an esophageal or hypopharyngeal injury in the setting of prior ACSS managed by the otolaryngology service at a tertiary, academic center between January 2015 and January 2019. Results. Six patients who experienced pharyngoesophageal perforation following ACSS are included in this study. Range of presentation was two weeks to eight years following initial hardware placement. Five patients presented with an abscess and all had evidence of perforation on initial CT or esophagram. All patients underwent repair with a sternocleidomastoid flap with two patients eventually requiring an additional pectoralis myofascial flap for a persistent esophageal leak. Five patients eventually attained ability to tolerate oral nutrition. An algorithm detailing surgical reconstructive management is proposed. Conclusions. Esophageal perforations in the setting of prior ACSS are challenging clinical problems faced by otolaryngologists. Consideration should be given to early drainage of abscesses and spine surgery evaluation. Spinal hardware removal is recommended whenever possible. Utilization of a pedicled muscle flap reinforces primary closure and allows coverage of the vertebral bony defect. Nutrition, thyroid repletion, and culture-directed IV antibiotics are necessary to optimize esophageal perforation repair.

Anterior cervical spine surgical site infection and pharyngoesophageal perforation. Ten-year incidence in 1475 patients

BackgroundSurgical site infection is reputed to be infrequent in anterior cervical spine surgery. Data on pathophysiological mechanism and risk factors are sparse. The relationship between local site infection and pharyngoesophageal perforation is unclear. The present study aimed: (1) to estimate the incidence of surgical site infection in anterior cervical spine surgery, (2) estimate the incidence of associated pharyngoesophageal perforation, and (3) suggest a decision-tree for early management of this two-fold issue. HypothesisAlthough with very low incidence, anterior cervical spine surgical site infection and pharyngoesophageal perforation are frequently associated. Material and methodsA 2-center retrospective study included all anterior cervical spine surgeries between January 1, 2007 and December 31, 2016. Data were provided by the two medical information departments. Patients undergoing anterior revision surgery on the cervical spine were included. Files were analyzed to determine whether the revision surgery was secondary to surgical site infection. ResultsIn total, 1475 patients with anterior cervical spine surgery were identified: 1180 in center A (80%) and 295 in center B (20%). The rate of revision surgery for surgical site infection was 0.34% (5/1475). There were 3 cases of pharyngoesophageal perforation (0.2%). DiscussionThe incidence of revision surgery for anterior cervical spine surgical site infection was comparable to rates in the international literature (0.07–1.6%). An association between surgical site infection and pharyngoesophageal perforation was frequent, but not statistically significant. This complication is extremely serious, requiring urgent multidisciplinary management. Level of evidenceIV, retrospective study.

Late-Onset Dysphagia From Hardware Migration After Anterior Cervical Discectomy and Fusion: An Unusual Cause and Review of Literature.

Post-operative dysphagia is the most common complication following anterior cervical discectomy and fusion (ACDF), with reports varying from 1% to 79%. We report a case of a 63-year-old female patient complaining of dysphagia presenting 9 years post surgery. The cause of dysphagia is often multifactorial with the true aetiology poorly understood. One potentially life-threatening cause of post-operative dysphagia is hardware migration associated with pharyngoesophageal perforation. This patient presents a unique case of a conservatively managed hardware migration with delayed onset dysphagia after 8 years of minimal symptoms. On further investigation, barium swallow identified a freely mobile screw in the oesophageal submucosa, rotating on swallowing. Retrieval of the screw was achieved transcervically with no visible perforation and resolution of dysphagia occurred 1 week post-operatively. Understanding the aetiology with early diagnosis and appropriate management of delayed hardware migration are paramount in reducing patient morbidity and potential life-threatening otolaryngologic complications.

Anterior Cervical Spine Osteosynthesis Complicated by Pharyngoesophageal Perforation

Anterior cervical spine surgery for traumatic or degenerative disease is a well-established procedure. However, complications such as pharyngoesophageal perforation can occur. In this study, we report a series of 6 pharyngoesophageal perforations after surgery. Based on the literature review, we analyzed pathogenesis, diagnosis and discussed therapeutic strategies. Three cases occurred after surgeries of traumatic cervical spine whereas the remaining were after surgeries for degenerative cervical myelopathy. The mean duration of surgery was 210 minutes. The symptoms, appearing 48 hours after surgery, were commonly hyperthermia, dysphagia, sore throat and swelling of the incision site. The diagnostic was confirmed after contrast-enhanced esophagography. The treatment strategies consisted of insertion of nasogastric feeding tube, oral intake restriction, intravenous antibiotics administration, wound drainage. Reoperation was necessary in 4 cases with removal of the hardware in three of them. One death occurred by pulmonary embolism in a tetraplegic patient. The occurrence of pharyngoesophageal perforation after cervical spine surgery can be disastrous. It can be avoided by increasing surgeon awareness during the surgical procedure. Early detection, immediate and multidisciplinary therapy are recommended to achieve the best outcomes.

IATROGENIC PHARYNGOESOPHAGEAL PERFORATION IN THE NEONATAL PERIOD - CLUES FOR CONSERVATIVE TREATMENT

Introduction: Iatrogenic perforation of the oesophagus in neonates is a rare condition, and it is most frequently seen in low birth weight infants. The commonly reported symptoms of these incidents are sudden onset respiratory distress and failure of endonasal feeding. Our series present an example of difficult nasogastric tube insertion followed by its stoppage at different thoracic levels, and failure to reach the abdomen as well as haemorrhage from the tube lumen. Material and Methods: Five premature infants suspected for the surgical pathology of the oesophagus are retrospectively discussed. Contrast chest X-ray was enough to establish the diagnosis. Clinical observation and intensive care were our first therapeutic method of choice. Results: In two cases the contrast material revealed a contrast depot parallel to the oesophagal lumen up to a point overlying the diaphragm, initially misdiagnosed for tubular duplication of the oesophagus. In another two cases, the contrast X-ray examination showed a normal oesophagal lumen with diverticulum-like enlargement in the upper third, initially misinterpreted as oesophagal atresia. The last case presented with pneumomediastinum and subcutaneous emphysema followed by apnea that required mechanical ventilation. Conclusion: Iatrogenic neonatal pharyngoesophageal perforation (PhEP) is a rare complication in the modern neonatal intensive care. Most cases can be treated conservatively; nevertheless, surgery presents an emergency option in severe cases. The correct interpretation of the X-ray image based on the previous history and clinical symptoms are crucial for the choice of the approach to appropriate treatments.

Flexible endoscopic treatment of Zenker's diverticulum: thirteen years' experience in Spain.

Flexible endoscopic treatment is one of the alternative approaches for the management of Zenker's diverticum. The present paper shows our short-term and long-term results with flexible endoscopic cricopharyngeal myotomy/septotomy. A retrospective analysis of our experience in patients with Zenker's diverticulum treated using a flexible endoscope, assisted by a flexible diverticuloscope, between 2002 and 2015. Myotomy/septotomy was performed with a needle-knife papillotome under deep sedation or general anesthesia. Among the 64 patients treated, two died within 10 days of surgery from causes not directly related to the procedure, and one presented with pharyngo-esophageal perforation, which recovered with conservative management at 47 days after admission. Four additional patients were lost to short-term follow-up. Among the 57 remaining patients, 52 had complete relief of dysphagia after 6 weeks. Eleven of these had recurrent symptoms on the mid and the long term. Eight were retreated with the same flexible endoscopic technique, one with a hybrid endoscopic approach, one with classical open surgery and one refused retreatment. After a mean follow-up of 2 years and a half, 33 of 37 patients reported absent or minimal dysphagia, controllable with punctual dietary restrictions. Flexible endoscopic treatment for Zenker's diverticulum is effective and safe. It represents an option on an equal footing to rigid endoscopy and classical open surgery and may also be used when the latter two are technically impracticable or contraindicated.

Iatrogenic pharyngoesophageal perforation and diverticulum formation conservatively managed in an adult patient

Iatrogenic pharyngoesophageal perforations represent serious problems that are difficult to diagnose and manage. We report a case of pharyngoesophageal diverticulum formation due to perforation after external transcervical polypectomy. The patient was refered to our endoscopy unit by otorhinolaryngologist 9 days after a surgical cervical polyp resection. He was in stable general condition, without sepsis. A nonoperative management was attempted with percutaneous endoscopic gastrostomy placement and broad-spectrum antibiotics. Nine weeks later esophagography demonstrated a complete regression of both the perforation and the diverticulum.

Management of Esophagus Perforation as a Late Term Complication of Vertebral Surgery: Case Report

Esophagus is the organ under risk of complications during many different types of surgical procedures. One of the most common iatrogenic traumas causing esophagus perforation is the cervical vertebrae surgery. Late term pharyngo-esophageal perforation is a rare but mortal complication of this surgery. Because of this reason, it is vital to take out the foreign material and to repair perforation. In this paper, the diagnosis and management period of a patient with esophagus perforation, 7 years after the percutaneous anterior discectomy and fusion with titanium cage procedure, due to the instrument placed on cervical vertebra, will be reported.