Analysis of Latent Esophageal Perforation Caused by a Mysteriously Migrated Anterior Cervical Plate Into the Gastrointestinal Tract.

Abstract

Anterior cervical implant migration through the pharyngoesophageal perforation is a very rare but serious condition that often necessitates surgical intervention. Nevertheless, rare cases have demonstrated recovery through conservative management. This article presents a 40-year-old man with dislodgement of an anterior cervical plate five years post-surgery. A last-minute radiography prior to salvage surgery revealed that the implant was no longer in its original position, and subsequent imaging traced its journey through the gastrointestinal tract. The esophageal perforation caused by the migrated implant was managed with a conservative approach. This study reviewed the literature of disappeared or naturally displaced cervical implants that resolved without surgery. An implant's disappearance or natural excretion is rare, with clinical presentations ranging from asymptomatic cases to severe symptoms such as dysphagia or oral expulsion. The time interval between surgery and implant excretion varies from five weeks to 11 years. Asymptomatic gastrointestinal elimination is more frequent in men, whereas oral expulsion predominates in women. Although younger patients generally recover faster, conservative management is also effective in older individuals. This study emphasizes the importance of last-minute radiological imaging prior to surgery in patients with implant dislodgement, and a "watch and wait" conservative approach should be considered in certain esophageal perforation cases. Additionally, a missing hardware could be considered to have been excreted through the gastrointestinal tract.