Introduction
Dysphagia is generally known as one of the most common postoperative complications following Anterior cervical dissectomy & fusion(ACDF) surgery. Therefore, it is easy to zero in on surgery as the cause of dysphagia when dysphagia occurs after surgery. It is, however, important to rule out all possible causes of dysphagia that might be attributed to patient's dysphagia. Hence, it is always necessary to rule out the additional causes of patient's dysphagia in the course of tests.
This is a case of a patient who underwent VFSS(Videofluoroscopic swallowing test) due to difficulty of swallowing that occurred after ACDF surgery, and incidentally found to have esophageal cancer on esophagogastroduodenoscopy(EGD) that was performed to rule out mechanical obstruction.
Case presentation
In December 21, 2018, a patient with a history of hypertension and thyroid cancer came to the emergency department of the hospital with forehead injury after falling forward. Several diagnostic tests were ordered, and found ankylosing spondylitis with C4/5 Fracture, thus the patient was admitted to the neurosurgery department for C4/5 ACDF with C3-6 anterior plating. In December 24, 2018, the patient underwent C4/5 total laminectomy & C3-7 posterior fusion.
VFSS was conducted on January 17, 2019 due to dysphagia after operation, and as a result of a measurement, 15% remnant with no aspiration in semisolid 4/8cc, 60% remnant with no aspiration in Solid 4/8cc, and positive penetration with no aspiration in liquid 4/8cc and cup drinking were observed. Due to the great amount of remnant observed in solid, patient underwent EGD to check the possibility of mechanical obstruction. (Figure 1) In the course of the test, there was incidental finding of esophageal cancer which is blocking 1/4 of the esophageal lumen. (Figure 2) The patient was then referred to a hemato-oncology department where PET-CT was ordered. (Figure 3) Additional tissue biopsy and plan to proceed for chemo-radiation therapy are currently on work.
Conclusion
When VFSS was first performed in this patient, the cause of dysphagia could be simply considered as postoperative dysphagia after ACDF surgery. However, there was great amount of remnant found in VFSS with solid components. To rule out the mechanical obstruction, EGD was ordered and eventually found an esophageal cancer in the patient.
Thus, even if dysphagia after surgery is a common complication, it is necessary to carefully examine and approach the patients with complaint of dysphagia after surgery, using VFSS to rule out other possible causes of dysphagia. In addition, there is a need to perform EGD for the patients presenting great amount of remnant in solid components, to measure the cause of mechanical obstruction. |
