Published online Aug 18, 2017. doi: 10.5312/wjo.v8.i8.651
Peer-review started: December 3, 2016
First decision: December 19, 2016
Revised: May 24, 2017
Accepted: June 6, 2017
Article in press: June 7, 2017
Published online: August 18, 2017
A 67-year-old female patient developed an esophagocutaneous fistula 4 mo after C4 and C5 partial corpectomy. Plain radiograph and computed tomography (CT) scan of cervical spine showed inferior screws pullout with plate migration that caused the esophageal perforation. Management included removal of anterior hardware, revision C4-5 corpectomy, iliac crest strut autograft and halo orthosis immobilization. The fistula was treated using antibiotics and a 10-french gauge rubber tube for daily irrigation and Penrose drain. At 3 mo, the esophagocutaneous fistula healed and the patient resumed oral feeding. Six months follow-up CT scan showed sound fusion with graft incorporation. At two-year follow-up, patient denied any neck pain or dysphagia. This case report presents a successful outcome of a conservative open wound management without attempted repair. The importance of this case report is to highlight this treatment method that may be considered in such a rare complication particularly if surgical repair failed.
Core tip: Esophageal perforation and subsequent fistulization is a known complication following anterior cervical spine surgery. As part of the treatment of this complication, hardware removal is commonly required. The majority of the literature advises against conservative treatment of esophageal injury due to the associated morbidity and mortality.