Esophageal Perforation Following C4–C6 Anterior Cervical Corpectomy With Anterior Plate Fixation: A Rare but Life-Threatening Complication Requiring Surgical Repair

Sep 28, 2026

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Anterior cervical corpectomy and fusion (ACCF) with anterior plate fixation is widely used for cervical spine trauma. A rare but potentially fatal risk is esophageal perforation. An 18-year-old male developed delayed perforation five weeks after C4–C6 ACCF. Computed tomography showed retropharyngeal air, and endoscopy confirmed a full-thickness defect. The hardware was removed, the injury was repaired primarily with absorbable sutures, drainage and feeding jejunostomy were performed, and complete recovery occurred without leakage at six months.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Abstract

Introduction

Case History, Examination and Management

Key Clinical Message

Delayed presentation and diagnostic workup

Surgical exploration and repair

Antibiotics and postoperative monitoring

Clinical Case Reports CASE REPORT OPEN ACCESS Esophageal Perforation Following C4–C6 Anterior Cervical Corpectomy With Anterior Plate Fixation: A Rare but Life-Threatening Complication Requiring Surgical Repair Maisam Gharayba1 | Nuha Riyad1 | Basem Bali1 | Mohammed Maree2 | Karam Rabi3 | Zaid Sawaftah1 | Osama Ewidat1 1Department of Medicine, An Najah National University, Nablus, Palestine | 2Makassed Charitable Society Hospital, East Jerusalem, Palestine | 3Department of General Surgey, Ibn Sina Specialized Hospital, Jenin, Palestine Correspondence: Osama Ewidat ([osamaewidat2026os@gmail.com](osamaewidat2026os@gmail.com)) Received: 17 May 2025 | Revised: 13 November 2025 | Accepted: 14 December 2025 Keywords: anterior cervical corpectomy and fusion | anterior cervical plate fixation | cervical spine trauma | delayed postoperative complication | esophageal perforation | postoperative complications | spinal fusion ABSTRACT Anterior cervical corpectomy and fusion (ACCF) with anterior plate fixation is a common procedure for cervical spine trauma. Although generally safe, it carries a risk of esophageal perforation—a rare but potentially fatal complication. We report an 18-year-old male who developed delayed esophageal perforation 5 weeks after C4–C6 ACCF. Diagnosis was established by computed tomography showing retropharyngeal air and endoscopy confirming a full-thickness esophageal defect. Surgical removal ofthe hardware, primary repair with absorbable sutures, drainage, and feeding jejunostomy were performed. The patient achieved complete recovery with no leakage at six-month follow-up. This case underscores the importance of clinical vigilance and timely surgical management. 1 | Introduction Anterior approaches to the cervical spine, first introduced in the 1950s, remain effective for managing trauma and degenerative conditions [1] . However, rare complications such as esophageal perforation may result in severe morbidity or mortality. The estimated incidence of esophageal injury during anterior cervical surgery is 0.2%–0.5%, and reported mortality ranges from 6% to 34% depending on the timing of diagnosis and management [2] . Early recognition and prompt intervention markedly improve survival and long-term outcomes [3] . Anterior cervical procedures such as anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (CDA), and corpectomy are considered safe, with low complication rates in large series [4] . Nevertheless, delayed esophageal perforation remains one of the most devastating complications, often caused by mechanical irritation from plates or screws. Here, we report a unique case of delayed perforation in an 18-year-old male 5 weeks after C4–C6 anterior cervical corpectomy and fusion with anterior plate fixation, emphasizing diagnostic challenges, management strategies, and preventive considerations [4] . 2 | Case History, Examination and Management An 18-year-old male with no significant past medical history sustained a C5 vertebral fracture after a diving accident, leading to complete spinal cord transection and quadriplegia. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2026 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd. Clinical Case Reports, 2026; 14:e71813 1 of 4 [https://doi.org/10.1002/ccr3.71813](https://doi.org/10.1002/ccr3.71813) Key Clinical Message This case highlights delayed esophageal perforation 5 weeks after anterior cervical corpectomy with anterior plate fixation in a young patient. Early recognition, prompt surgical intervention, and vigilant long-term follow-up are crucial to prevent life-threatening complications. He underwent anterior cervical corpectomy and fusion (ACCF) with anterior plate fixation spanning C4–C6 . Postoperatively, he require

FAQs

When did the esophageal perforation occur after surgery?

The patient developed delayed esophageal perforation five weeks after C4–C6 anterior cervical corpectomy and fusion with anterior plate fixation.

How was the perforation diagnosed?

Non-contrast cervical CT demonstrated abnormal retropharyngeal air, and upper gastrointestinal endoscopy confirmed a full-thickness esophageal defect.

What surgical and supportive measures were performed?

Hardware was removed, the defect was repaired in multiple layers with absorbable sutures, a drain was placed, and feeding jejunostomy was used to maintain nutrition during healing.

Sep 28, 2026

Uploaded by Callum