Delayed esophageal pseudodiverticulum after anterior cervical spine fixation: report of 2 cases.
BACKGROUND
Although perforation of the esophagus, in the anterior cervical spine fixation, is well established, cases with delayed onset, especially cases that present pseudodiverticulum, are not common. In addition, management of the perforation in this situation is debated.


METHODS
Delayed esophageal pseudodiverticulum was managed in two patients with a history of anterior spine fixation. Patients were operated on, the loose plate and screws were extracted, the wall of the diverticulum was excised, the perforation on the nasogastric tube was suboptimally repaired, and a closed suction drain was placed there. The NGT was removed on the 7th day and barium swallow demonstrated no leakage at the operation site; therefore, oral feeding was started without any problem.


CONCLUSIONS
In cases with delayed perforation, fistula, or diverticulum removal of anterior fixation instruments, gentle repair of the esophageal wall without persistence on definitive and optimal perforation closure, wide local drainage, early enteral nutrition via NGT, and antibiotic prescription is suggested.
Department of Thoracic Surgery, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Ali
A
Sadrizadeh
Acute Care Surgery Research Center, Taleghani Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Ehsan
E
Soltani
Acute Care Surgery Research Center, Taleghani Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Mehdi
M
Abili
Acute Care Surgery Research Center, Taleghani Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Paria
P
Dehghanian
Anterior cervical spine fixation; Conservative management; Delayed postoperative complication; Esophageal diverticulum; Esophageal perforation; Fistula management; Plate fixation