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Diagnostic and Management Challenges of Esophageal Rupture with Concomitant Cervical Abscess in Chronic High Cervical

Junghwan Park1, Dong Gyu Lee1

  • 1Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu 42415, Republic of Korea.

Diagnostics (Basel, Switzerland)
|February 24, 2024
PubMed

Insights

This case report details a rare esophageal rupture following anterior cervical discectomy and fusion (ACDF). Prompt diagnosis and management are crucial for preventing severe complications in ACDF patients with spinal cord injury.

Area of Science:

  • Neurosurgery
  • Infectious Disease
  • Gastroenterology

Background:

  • Persistent fever and recurrent infections after cervical surgery can indicate serious complications.
  • Spinal cord injury and cervical tetraplegia can mask typical symptoms of esophageal injury.
  • Anterior cervical discectomy and fusion (ACDF) carries a risk of rare but severe complications.

Purpose of the Study:

  • To highlight a challenging case of esophageal rupture following ACDF in a patient with pre-existing spinal cord injury.
  • To emphasize the diagnostic difficulties posed by atypical presentations of esophageal rupture.
  • To underscore the importance of considering esophageal rupture in the differential diagnosis of post-ACDF infections.

Main Methods:

  • A 65-year-old patient with a history of spinal cord injury and ACDF presented with recurrent cervical abscesses and fever.
  • Diagnostic imaging (MRI) and endoscopy were utilized to identify the source of infection and complications.
  • Management involved antibiotic therapy, percutaneous endoscopic gastrostomy, and consideration of surgical risks.

Main Results:

  • An esophageal rupture was identified, complicated by protruding cervical fusion hardware.
  • Diagnosis was challenging due to the absence of typical imaging findings and masked pain responses from tetraplegia.
  • Percutaneous endoscopic gastrostomy was performed, successfully managing the infection without recurrence.

Conclusions:

  • Esophageal rupture is a rare but critical complication of ACDF, particularly in patients with neurological deficits.
  • High cervical tetraplegia can significantly alter symptom presentation, complicating diagnosis.
  • Clinicians must maintain a high index of suspicion for esophageal rupture in ACDF patients with persistent or recurrent infections, even without classic symptoms.
Keywords:
cervical fusionesophageal rupturepyogenic spondylitistetraplegia

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