Esophageal Perforation After Fracture of the Cervical Spine: Case Report and Review of the Literature

Abstract

We present a posttraumatic esophageal tear that occurred in a 55-year old patient after a truck accident. He sustained a two-level injury with a type II odontoid fracture and a unilateral fracture of the left superior articular process of C6 with an incomplete quadriplegia at C5. Both lesions were treated nonoperatively. The tear was attributed to the stretching of the esophagus over anterior degenerative spurs at the level of the lesion (C5-C6) during hyperextension. The diagnosis of the esophageal perforation was delayed for 6 days. The treatment consisted of surgical debridement, volume expansion, antibiotic therapy, hyperbaric oxygenation, assisted ventilation, and esophageal exclusion. A complete review of the literature was performed.

Esophageal injury in fatal rear-impact collisions

“…However, when present, the injury carries with it a substantial risk of mortality (50% in the present data), a risk that is magnified by delayed diagnosis [8,24]. Clinicians should be aware of the potential for significant complications in the whiplash trauma-exposed patient who complains of chest pain, mid-thoracic pain, discomfort in the neck and throat, respiratory distress, or hoarseness [8,9,26]. As the present review demonstrates, significant esophageal injuries resulting from whiplash trauma have only been previously reported a few times in the literature, and this is likely due to a genuinely low incidence of such injuries.…”

“…In contrast, whiplash trauma associated with rear-impact collisions is an inertial injury mechanism, in which the natural kyphotic curve of the thoracic spine is initially straightened by contact with the seat back, resulting in axial compression of the spine, and then extension of the lower cervical spine as the torso is advanced forward against the inertial resistance of the head [19]. Because of the potential for direct trauma it is not surprising that the majority of published cases of traffic crashrelated esophageal injury involve a frontal collision vector, a finding that is mirrored in the distribution of the crash vectors described in the NASS cases described in Table 2 (48% were frontal collisions) [9,10,17,18,[20][21][22][23][24][25][26]. During frontal collisions the anterior neck organs are exposed to the potential for direct contact with a steering wheel, dashboard, deploying airbag, or even windshield.…”

“…Esophageal injuries are most often due to iatrogenic factors [8], but MVC trauma is also described in the literature [8][9][10]. Rear-impact collisions expose the occupants to a well described kinematic pattern, initially involving straightening and upwards movement (ramping) of the torso resulting in axial compression of the spinal column, followed by segmental hyperextension of the lower cervical spine and then global Forensic Science International 206 (2011) e52-e57 Neck injuries resulting from motor vehicle collisions (MVC), often referred to as whiplash trauma and injury, often demonstrate little or no evidence of significant tissue damage.…”

The Role of the Sternocleidomastoid Muscle Flap for Esophageal Fistula Repair in Anterior Cervical Spine Surgery

“…Nonpenetrating traumatic perforations occur via two mechanisms: hyperextension and laceration of the esophagus by anterior cervical osteophytes or entrapment of the esophageal wall between vertebral bodies at the time of reduction. 6 Penetrating trauma can also cause this complication, and a potential strategy to repair the defect should be kept in mind. Another cause of nonsurgical esophageal perforation is intubation.…”

Komplikationen bei Densfrakturen

“…Einen ähn li chen Ver let zungs me cha nismus be schrie ben Ne rot et al [42] bei einem 55-jäh ri gen Pa ti en ten mit Dens fraktur (Typ II).…”