Iatrogenic pharyngoesophageal perforations treated with fully covered self-expandable metallic stents (with video). Surg Endosc. 2015;29:987-991. [PMID: 25149633 DOI: 10.1007/s00464-014-3767-4]

Oropharyngeal perforation caused by Hangman's fracture: a case report and literature review

PURPOSE

Oropharyngeal perforation is extremely rare but dreaded. The majority of previous reported cases were iatrogenic. Till now, there is no report of traumatic oropharyngeal perforation secondary to a cervical fracture. We report a case of oropharyngeal perforation identified in anterior cervical discectomy and fusion (ACDF).

METHODS

A 78-year-old patient falling from a bicycle was diagnosed with C2 fracture. The patient complained of neck pain, odynophagia and hoarseness. No neurological deficit was identified. Radiographic examinations showed a type I Hangman's fracture of C2. Intraoperatively, an approximately 3 cm of perforation was identified in the oropharynx, exposing the orotracheal intubation tube. The perforation was then sutured using resorbable 5/0 thread without applying excessive tension on the wound edges, which was followed by a regular ACDF at the level of C2/C3. A nasogastric tube was inserted to prevent complications. The patient received intravenous antibiotic therapy and oral administration of ciprofloxacin to prevent infections.

RESULTS

The oropharyngeal perforation was resolved with considerable improvement in clinical signs after surgery (Aiolfi et al. in World J Emerg Surg 12(1):1-7, 2017. 10.1186/S13017-017-0131-8/TABLES/5). Follow-up radiological evaluation confirmed solid fusion and cervical spine stability, as well as the closure of the perforation on radiopaque X-rays.

CONCLUSION

Oropharyngeal perforation caused by cervical fracture is an extremely rare complication. High intraoperative suspicion rate is required to identify perforations that might be missed by regular radiological diagnosis. The combination of upper endoscopy and barium swallow study yields an almost 100% diagnosis accuracy. Early surgical treatment is of paramount importance to prevent major complications, cervical fracture with lesions of the pharynx often associates with an ankylosing spondylarthritis.

What Is New with Cervical Perforations? A Clinical Review Article

Approximately 15% of all esophageal perforations occur within the cervical esophagus. Advances in medical care and surgical technique overtime have led to decreased mortality associated with esophageal perforations. While early recognition, accurate characterization, and adequate drainage, or repair when appropriate, remain the mainstays in the management of cervical perforations, endoscopic innovation has provided a minimally invasive option in the management of this disease and expanded the armamentarium of options available to providers.

Assessment and treatment of hypopharyngeal and cervical esophagus injury: Literature review

Wounds and perforations of the upper gastrointestinal tract are serious and life-threatening. The hypopharynx and cervical esophagus, by their respective anatomical positions, are exposed to traumatic wounds, most often during diagnostic tests, but management such wounds remains a subject of discussion. The present article analyzes the current state of knowledge on epidemiology, etiologies, risk factors, diagnostic management, prognostic factors and available treatments.

Endoscopic Management of Esophageal Perforations: Who, When, and How?

Esophageal perforations can be spontaneous or iatrogenic. Although they are a rare occurrence, they are associated with a significant morbidity and mortality. Traditionally, management of esophageal perforation consisted of surgery. However, endoscopic management is now emerging as the primary treatment modality and is less invasive and morbid than surgery. Endoscopic modalities include through-the-scope clips (TTS), over-the-scope clips (OTSC), placement of covered stents, and suturing. Suturing can be used for primary closure of the perforation as well as anchoring of stents to prevent migration. Smaller defects (<2 cm) can be closed with clips (TTS or OTSC), whereas larger defects require a stent placement or suturing to achieve closure. If the perforation is associated with a mediastinal collection, drainage is mandatory and can be done via CT-guided percutaneous drainage, surgery, or endoscopic vacuum therapy.

New devices and techniques for endoscopic closure of gastrointestinal perforations

Gastrointestinal perforations, which need to be managed quickly, are associated with high morbidity and mortality. Treatments used to close these perforations range from surgery to endoscopic therapy. Nowadays, with the development of new devices and techniques, endoscopic therapy is becoming more popular. However, there are different indications and clinical efficacies between different methods, because of the diverse properties of endoscopic devices and techniques. Successful management also depends on other factors, such as the precise location of the perforation, its size and the length of time between the occurrence and diagnosis. In this study, we performed a comprehensive review of various devices and introduced the different techniques that are considered effective to treat gastrointestinal perforations. In addition, we focused on the different methods used to achieve successful closure, based on the literature and our clinical experiences.

Regenerative Medicine Strategies for Esophageal Repair

Pathologies that involve the structure and/or function of the esophagus can be life-threatening. The esophagus is a complex organ comprising nonredundant tissue that does not have the ability to regenerate. Currently available interventions for esophageal pathology have limited success and are typically associated with significant morbidity. Hence, there is currently an unmet clinical need for effective methods of esophageal repair. The present article presents a review of esophageal disease along with the anatomic and functional consequences of each pathologic process, the shortcomings associated with currently available therapies, and the latest advancements in the field of regenerative medicine with respect to strategies for esophageal repair from benchtop to bedside.