Esophageal Complications From Anterior Neck Surgery: An Elusive Cause of Dysphagia

Background The anterior cervical region serves as the access point to various surgical procedures including both thyroid and cervical spine operations. Both areas of surgery grow more common with improved detection modalities and better techniques leading to improved surgical outcomes. Unfortunately, the impact of such surgeries can affect surrounding structures including the esophagus. We present a case of esophageal dysphagia secondary to cervical esophageal diverticulum likely from prior neck surgeries leading to violation of the muscle of the esophagus. Methods A 36 year old women with a history of anterior cervical discectomy and fusion (ACDF) in September 2022 and papillary thyroid cancer status post right thyroid lobectomy in August 2023 presented with months of dysphagia. Patient reported sticking sensation at base of throat to both solids and liquids and intermittent regurgitation of swallowed food and secretions. Patient underwent multiple testing modalities including three EGDs, ENT evaluation, high resolution manometry(HRM), and modified barium swallow (MBS) to finally understand cause of dysphagia symptoms. Results Patient had two normal EGDs both with empiric dilation without improvement. There was concern for possible motility disorder vs oropharyngeal dysphagia. Therefore modified barium swallow (MBS) was done, which showed proximal esophageal diverticulum. Third EGD was done one month later without evidence of esophageal diverticulum. Second MBS was done, which again revealed cervical esophageal diverticulum where contrast and food were retained and patient was sensate to. High resolution manometry(HRM) confirmed normal esophageal peristalsis. Etiology was thought to be secondary to cervical esophageal diverticulum likely from prior neck surgeries leading to violation of the muscle of the esophagus. Conclusion Dysphagia is a known complication following both thyroid surgery and ACDF. However, esophageal diverticulum is rare complication and has been presented in literature fewer than 25 times. This case highlights the importance of multimodal diagnostic approach to disorders of swallowing. Although EGD is an important first step in diagnosis, if it is normal, further testing like MBS or HRM should be done or there may be delays in patient diagnosis and treatment.