Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Aug 18, 2017; 8(8): 651-655
Published online Aug 18, 2017. doi: 10.5312/wjo.v8.i8.651
Open wound management of esophagocutaneous fistula in unstable cervical spine after corpectomy and multilevel laminectomy: A case report and review of the literature
Hossein Elgafy, Mustafa Khan, Jacob Azurdia, Nicholas Peters
Hossein Elgafy, Mustafa Khan, Jacob Azurdia, Nicholas Peters, Department of Orthopedics, University of Toledo Medical Center, Toledo, OH 43614-5807, United States
Author contributions: All the authors contributed in outlining the manuscript, gathering the data, and writing the manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at University of Alabama in Birmingham.
Informed consent statement: The patient involved in this study gave her written informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: None of the authors have any financial or other conflicts of interest that may bias the current study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hossein Elgafy, MD, MCH, FRCSED, FRCSC, Department of Orthopaedics, University of Toledo Medical Centre, 3065 Arlington Avenue, Toledo, OH 43614-5807, United States. hossein.elgafy@utoledo.edu
Telephone: +1-419-3833515 Fax: +1-419-3833526
Received: November 28, 2016
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
Abstract

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.

Keywords: Wound management, Esophagocutaneous fistula

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.