Esophagocutaneous Fistula: A Rare Complication of Ultrasound-Guided Percutaneous Ethanol Ablation for Recurrent Papillary Thyroid Carcinoma Nodal Metastasis.

Abstract

Percutaneous ethanol ablation (PEA) is a minimally invasive option for locoregional nodal recurrence in papillary thyroid carcinoma (PTC) when reoperation carries high risk. Esophagocutaneous fistula is an extremely rare complication of this procedure. A woman in her early 70s with a history of total thyroidectomy, radical neck dissection, and radioactive iodine therapy developed an isolated left supraclavicular nodal recurrence. Ultrasound-guided PEA was performed. One month later she presented with purulent neck discharge. Contrast-enhanced CT with oral contrast, oesophagoscopy, and subsequent surgical exploration were performed. Imaging and endoscopy confirmed a 2-cm esophagocutaneous fistula tract. The patient was managed with enteral nutrition followed by primary esophageal closure reinforced with a pedicled pectoralis major myocutaneous flap. The postoperative course was complicated by a surgical site infection that resolved with conservative care. Follow-up Gastrografin swallow showed no leak and the patient resumed a full oral diet. This is the first reported case of esophagocutaneous fistula following cervical PEA. Although this complication appears exceptionally rare, awareness and preventive strategies are particularly important in previously operated and irradiated necks. Prompt imaging and multidisciplinary surgical repair are essential for successful outcomes.