Pharyngoesophageal Perforations Research Articles

Pharyngo-Esophageal Perforations After Anterior Cervical Spine Surgery: Management and Outcomes

To report about the diagnosis, surgical treatment, and postoperative management of pharyngo-esophageal perforations (PEPs) after anterior cervical spine (ACS) surgery in 17 patients. A retrospective multicenter case series of patients surgically treated for PEP after ACS surgery was performed. Data regarding cervical spine pathology and surgery, comorbidities, diagnosis and surgical management of PEP, airway management, antibiotic therapy, postoperative course, and feeding route after repair surgery at discharge and last follow-up were collected. Seventeen patients were included in the study, for a total of 22 surgical procedures for PEP repair. Seven PEPs (41%) had early onset, whereas 10 (59%) were delayed. All patients underwent PEP surgical repair through an anterior prevascular retrovisceral cervicotomic approach, consisting of multiple layer sutures of the perforation, with flap interposition. Despite the challenging management of these patients, 16 of 17 patients from our series restored oral feeding. PEPs are among the most appalling complications of cervical spine surgery. Because of their rarity and heterogeneous presentation, a standardized management is difficult to define. From our experience with the largest case series in the literature, a multidisciplinary approach is advisable to deal with these patients.

Iatrogenic pharyngoesophageal perforations treated with fully covered self-expandable metal stents: Case report

Iatrogenic pharyngoesophageal perforations treated with fully covered self-expandable metal stents: 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 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 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.

Multidetector Computed Tomography of Pharyngo-Esophageal Perforations

Perforation of the esophagus remains a diagnostic and therapeutic challenge. Currently, the most common cause of perforation is instrumentation of the esophagus, but other conditions such as foreign body, trauma, or spontaneous rupture are possible entities in the clinical practice. Multidetector computed tomography has become the imaging technique of choice in the evaluation of this setting of patients because of its capability to depict all the different signs associated with the degrees of wall impairment. By being aware of the appearance of the various entities that affect the esophagus, the radiologist can play an important role in detecting and staging esophageal injuries.

Spontaneous pharyngoesophageal perforations

We report a case of spontaneous multiple perforations of pharyngoesophagus presenting with odynophagia and chest pain. Computed tomography identified a deep neck infection with necrotizing mediastinitis, and esophagography showed leakage of contrast from the pharyngeal wall, pyriform sinus, and thoracic esophagus. Empiric antibiotics, adequate debridement, and resection of the ruptured esophagus with reconstruction were required for complete resolution of the patient's symptoms. Although the simultaneous multiple perforations involving pharyngoesophagus are rare, clinicians should not neglect its possible occurrence.

Pharyngoesophageal intubation injuries: Three case reports

The hypopharynx and cervical esophagus are particularly vulnerable to intubation trauma. Contributing factors include hasty intubation by inexperienced personnel; the use of curved, beveled endotracheal tubes containing stylets; malpositioning of the head, and the application of cricoid pressure. latrogenic pharyngoesophageal perforations may go unsuspected until characteristic signs and symptoms are recognized. These include cervical pain, fever, dysphagia, leukocytosis, subcutaneous emphysema, and pneumomediastinum. We present three cases that illustrate important points in recognizing, evaluating, and treating pharyngoesophageal perforations. The third case presents a chronic cervical esophageal perforation with secondary pseudodiverticulum, requiring resection of the pseudodiverticulum and a primary sternocleidomastoid muscle flap repair of the cervical esophageal defect. To our knowledge, this technique has not previously been reported.