Dr Chandra Puli
We report a case of a patient presenting with Boerhaave’s syndrome who developed a rare, reversible neurological complication, Collet-Sicard syndrome. A 30-year old male presented with a two-day history of acute abdominal pain and vomitting. On admission he was pyrexic, tachycardic and hypoxic. A CT of the chest, abdomen and pelvis showed air in the mediastinum and upper abdomen as well as considerable mediastinitis extending into the neck. CT with gastrografin showed extravasation of contrast into the mediatstinum, indicating an oesophageal perforation. The patient was admitted to the ITU and underwent a diagnostic laparoscopy with washout and drain placements. This was followed by an OGD with insertion of a fully covered oesophageal stent. The stent was removed after two weeks following complete healing. However, the patient experienced residual dysphagia related to neuromuscular palatal and tongue dysmotility. The patient was diagnosed with Collet-Sicard syndrome, a rare condition involving unilateral palsy of the lower cranial nerves. It was likely caused by mediastinitis that extended to the internal jugular foramen and caused temporary paralysis of cranial nerves IX, X, XI and XII. Eventually, control of the mediastinitis and inflammation in the subcutaneous neck facia led to the patient regaining normal function
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