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Vol. 33. Issue 3.
Pages 149-154 (May - June 2022)
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Vol. 33. Issue 3.
Pages 149-154 (May - June 2022)
Case Report
Hypopharynx injury in anterior cervical discectomy: Failure of surgical repair: Case report
Lesión de la hipofaringe en la discectomía cervical anterior: fracaso de la reparación quirúrgica: informe de caso clínico
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Muhammet Arif Ozbeka,
Corresponding author
m_a_ozbek@yahoo.com

Corresponding author.
, Nazlı Cakıcıb, Ahmet Tulgar Basakc
a Neurosurgery Clinic, Haseki Training and Research Hospital, Istanbul, Turkey
b Medicana Internatiınal Hospital, Department of Neurosurgery, Istanbul, Turkey
c Neurosurgery Department, American Hospital, Istanbul, Turkey
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Abstract

Hypopharynx injury is a very rare complication of the anterior cervical spine surgery. It is imperative that the complication is managed appropriately with a multidisciplinary approach. In this case, 52 year old male patient underwent C3-4, C4-5, and C5-6 anterior cervical microdiscectomy with interbody fusion and anterior cervical plate surgery. Patient was discharged on the postoperative day 2 with full recovery. During the first follow up at week 1, the patient was found to have leakage of sputum from the incision line. Radiological imaging studies revealed a hypopharynx fistula.

First prophylactic course of antibiotic therapy was given; upon persistent leakage from the incision site, it was deemed appropriate to perform hypopharynx repair surgery. However, surgical treatment was not successful, and leakage continued. Thereupon, a controlled sterile environment for secondary granulation was created. Eventually, the leakage was stopped with antibiotic and supporting treatment at the end of week 6. The patient was closely followed for one year. During the one year follow up, the patient did not have any complaints, such as discharge, nor he had any infections.

The use of methylene blue in the diagnosis of esophagus perforation, which has high mortality and morbidity rate, provided great benefit. The risk of infection was prevented by creating a sterile environment with a mini colostomy bag.

Keywords:
Anterior cervical discectomy
Hypopharynx injury
Hyphopharynx fistula
Resumen

La lesión de hipofaringe es una complicación muy rara de la cirugía de columna cervical anterior. El manejo apropiado y multidisciplinario de esta complicación es muy importante. Presentamos el ejemplo de un paciente varón de 52 años de edad, que se sometió a microdiscectomía cervical anterior, C3-4, C4-5 y C5-6, con fusión intersomática vertebral y cirugía de placa cervical anterior. Después de ser dado de alta, alrededor del segundo día del postoperatorio, se observó que el paciente tenía una fuga de esputo a través de la herida y línea de incisión, durante la primera semana a su visita clínica. Los estudios de imágenes radiológicas revelaron una fístula a nivel de la hipofaringe.

Posteriormente se le administró el primer curso de antibioticoterapia profiláctica, tras observar una continua fuga a través de la herida. Inmediatamente se procedió a realizar una cirugía de reparación de la hipofaringe. Sin embargo, el tratamiento quirúrgico no demostró éxito alguno y la supuración continuó. A continuación, se intentó crear un entorno estéril controlado para permitir la granulación secundaria. Eventualmente el drenaje y la supuración se detuvieron con el uso de antibióticos y tratamiento de soporte al final de las seis semanas. Se le dio seguimiento al paciente durante un año. Durante este periodo no se presentaron problemas asociados con la herida o signos de infección.El uso de azul de metileno en el diagnóstico de las perforaciones esofágicas, las cuales tienen un alto índice de mortalidad y morbilidad, demostró gran beneficio en este caso. El riesgo de infección fue prevenido creando un ambiente estéril con el uso de una bolsa de minicolostomía.

Palabras clave:
Discectomía cervical anterior
Lesión de hipofaringe
Fístula de hipofaringe

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