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Journal of Trauma and Injury 2012;25(4):278-282.
Esophageal Fistula Related to Anterior Cervical Spine Surgery after Severe Cervical Trauma
Sung Hwa Paeng
Department of Neurosurgery, College of Medicine, Inje University Busan Paik Hospital, Busan, Korea. shpaeng@empas.com
심한 경추부 외상후에 전방 경추부 수술후 발생한 식도의 누공
팽 성 화
인제대학교 부산백병원 신경외과
Received: 9 November 2012   • Revised: 26 November 2012   • Accepted: 1 December 2012
Abstract
An esophageal perforation following anterior cervical fusion is rare. Early development of an esophageal perforation after anterior cervical fusion is usually due to iatrogenic injury from retraction, injury associated with the original traumatic incident, improperly placed instruments or a bone graft. A 31-year-old man had a cervical dislocation and spinal cord injury because of severe cervical trauma after a traffic accident. He was quadriplegic and had no feeling below T4 dermatome. Anterior decompression of the cervical spine and anterior fusion with mesh with autobone were performed. An esophagocutaneous fistula occurred 7 days after anterior cervical surgery. A second anterior surgery was done because of pus drainage. The mesh was changed with an iliac bone graft, and the esophagocutaneous fistula site was primary repaired, but pus continued to drain. Conservative treatment, which consisted of wound drainage and intravenous administration of antibiotics, was tried, but was unsuccessful. After all, we removed the plate and screws, but did not removed the iliac bone graft, We closed the esophageal fistula, and transposed the sternocleidomastoid muscle flap to the interspace between the esophagus and the cervical spine. The wound to the esophagus was well repaired. In conclusion, precautionary measures are needed to avoid the complication, and adequate treatment is necessary to resolve those complications when they occur.
Key Words: Esophagocutaneous fistula; Anterior cervical fusion
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