Diagnostic and Management Challenges of Esophageal Rupture with Concomitant Cervical Abscess in Chronic High Cervical Tetraplegia

A 65-year-old patient with a history of spinal cord injury and previous cervical surgery experienced a persistent fever despite antibiotic treatment. Further investigation revealed an abscess in the neck and subsequent endoscopy showed an esophageal rupture with protruding cervical fusion metal. Due to the risks associated with surgery, a percutaneous endoscopic gastrostomy was performed, which resolved the infection without recurrence. The diagnosis was complicated by the absence of typical imaging signs of esophageal rupture and the patient's high cervical tetraplegia, which masked typical pain responses.

• 1
  Esophageal rupture can occur as a rare complication following cervical surgery, even in chronic cases.
• 2
  The symptoms of esophageal rupture can be masked in patients with high-level complete cervical injuries due to an inability to accurately perceive and localize pain.
• 3
  Infection can spread through the cervical fascia from superficial to deep cervical areas, making diagnosis challenging.