Difficult intubation resulting in surgical repair of esophageal and hypopharyngeal perforation.

Although rare, perilous injury of the aerodigestive tract due to traumatic endotracheal intubation can have devastating consequences for patient and provider. Resulting serious complications of injury may involve esophageal perforation, pneumomediastinum, mediastinitis, retropharyngeal abscess, vocal cord paralysis, arytenoids dislocation, and hypopharyngeal pseudodiverticulum. Morbidity, mortality, and legal and financial consequences can be enormous. Early identification and treatment of suspected injury will promote patient recovery and thwart life-threatening progression of injury. This case report presents a 70-year-old woman scheduled for an elective hip arthroplasty. Intraoperatively she was unable to be intubated, and her operation was canceled. In the post-anesthesia care unit, the patient underwent an otolaryngology consultation and was admitted for observation of reactive airway edema. Pharyngoesophageal perforation was diagnosed several days later and required surgical repair.