A rare etiology of esophageal perforation

A 74-year-old male with a history of diabetes and Parkinson's disease presented to our hospital due progressive dysphagia for 3 months. He also had frequent choking been admitted another pneumonia before visiting hospital. surgery anterior cervical discectomy fusion (ACDF) 16 years ago osteomyelitis myeloradiculopathy. Cervical roentgenograms showed migrated plate-locking screws, indicating malposition fixation screw over C7-T1 (Figure 1A). Esophagogastroduodenoscopy was performed assess the 2). What is diagnosis this patient? The esophagogastroduodenoscopy revealed head eroded into esophageal lumen. exam stopped promptly avoid possible complications air inflation. Computed tomography neck disclosed focal gas accumulation in esophagus at C7 level just plate. penetrated through lumen 1B). incidence perforation after ACDF low (<1%).1 symptoms includes (57%), swelling and/or discharge (21%), (11%), odynophagia, sore throat (7%), hoarseness, breathing difficulty (7%).2 related based on esophagogastroduodenoscopy, upper gastrointestinal series, or esophagogram. Most delayed pharyngoesophageal perforations occurred less than 1 year from time ACDF. Vrouenraets reported case 9 post-ACDF background chronic esophagitis.3 Our patient experienced complication surgery. This frame longest ever literature. Clinicians should consider differential when managing patients Computer GI series be if screws. Chia-Chang Chen: endoscopist who final approval drafting manuscript. Chih-Chi Tsai: Final Yen-Chun Peng: authors declare no conflict interest. Written informed consent obtained patient.