PDF(Pubmed)
Abstract：
A 65-year-old with a history of spinal cord injury and previous cervical surgery presented with persistent fever despite antibiotic treatment. MRI scans revealed an abscess in the neck extending from C3 to C6, with associated osteomyelitis. After an initial discharge following antibiotic therapy, the patient was readmitted due to recurrent systemic infection symptoms and another abscess. A subsequent endoscopy showed esophageal rupture with protruding cervical fusion metal. Due to operative risks, a percutaneous endoscopic gastrostomy was performed without further infection recurrence. The absence of typical imaging signs of esophageal rupture made diagnosis difficult. The infection spread through the cervical fascia from superficial to deep cervical areas. Esophageal rupture, a rare complication of cervical surgery, presents with varying symptoms depending on its location and was particularly challenging to diagnose in this patient due to high cervical tetraplegia, which masked typical pain responses. Therefore, this case highlights the need to consider esophageal rupture in differential diagnoses for chronic ACDF patients, even when typical symptoms are absent.
摘要：
65岁，有脊髓损伤史，既往颈椎手术史，尽管接受抗生素治疗，但仍持续发烧。MRI扫描显示颈部脓肿从C3延伸至C6，并伴有骨髓炎。抗生素治疗后初次出院后，由于反复出现的全身感染症状和另一个脓肿，患者再次入院。随后的内窥镜检查显示食管破裂，宫颈融合金属突出。由于手术风险，进行了经皮内镜下胃造瘘术,无进一步感染复发.缺乏典型的食管破裂影像学征象使诊断困难。感染通过颈筋膜从浅颈区域传播到深颈区域。食管破裂,颈椎手术的罕见并发症,表现出不同的症状，取决于其位置，是特别具有挑战性的诊断在该患者由于高颈椎四肢瘫痪，掩盖了典型的疼痛反应。因此,这种情况突出了在慢性ACDF患者的鉴别诊断中需要考虑食管破裂，即使没有典型症状。
