Food Impaction Complicated by a Type Three Odontoid Fracture

Introduction: Most common etiologies of food impactions are Schatzki rings, eosinophilic esophagitis, esophageal dysmotility, dentures, and/or extrinsic compression. They are considered to be endoscopic emergencies and require endoscopic intervention in a prompt manner to avoid respiratory complications. Esophagogastroduodenoscopy (EGD) should be performed within six hours of admission unless contraindication(s) preclude emergent endoscopy. Here, we describe a challenging case of an elderly male with a type three odontoid fracture who presented with food impaction. Case Description/Methods: The patient is an 83-year-old male who sustained a traumatic fall and was found to have a type three odontoid fracture. He was evaluated by neurosurgery and was placed on a Miami-J Collar for six weeks. During the hospitalization, he had a dysphagia evaluation and was deemed to be able to tolerate soft solids and thin liquids with aspiration precautions. He was discharged home but presented to the hospital ten days later with progressive worsening dysphagia. On fiberoptic endoscopic evaluation performed by otolaryngology, there was notable cricoid edema, erythematous epiglottis, and arytenoid edema. Computed tomography of the neck was performed, revealing a distended esophagus filled with debris and stable type three odontoid fracture. After neurosurgical evaluation, the patient was transferred to the endoscopy unit, intubated, and underwent upper endoscopy. Undigested soft food was noted throughout the esophageal lumen and was evacuated utilizing Roth net, aggressive irrigation, and displacement into the gastric cavity via gentle pressure. The patient tolerated the procedure well and was extubated prior to transfer to the recovery room. Discussion: Odontoid fractures commonly occur in the elderly and account for 20% of all cervical spine injuries. There is an association with dysphagia in patients suffering from odontoid fractures due to cervical instability. Early extraction of the food impaction is crucial in minimizing pressure-induced mucosal damage of the esophagus and aspiration. Intubation should be performed with special attention to neck immobilization to prevent the progression of cervical trauma. It is imperative to arrange a safety plan with a neurosurgeon in patients with cervical fractures who require upper endoscopy to avoid spinal cord injury.Figure 1.: (Top Left) type 3 odontoid fracture, (Bottom Left) Food impaction seen on CT, (Top Right) Different types of Odontoid fractures, (Middle Right) Food impaction in esophagus seen on EGD, (Bottom Right) Esophagus s/p removal of food impaction.