Disclosures: Lauren A. White, DO, MPH: Nothing to disclose

Case Description: The patient presented for nausea and vomiting. Subsequently diagnosed with necrotizing pancreatitis and underwent multiple procedures for debridement and small bowel resection over one month. Total parenteral nutrition (TPN) was started due to anastomotic leak. He had several separate endotracheal intubations and nasogastric tube placements throughout his hospitalization. Speech pathology noted frequent wet cough, difficulty managing secretions, and wet voice following oral intake. Patient also complained of near choking and difficulty initiating swallow, new since hospitalization. Incidentally, modified barium swallow showed large osteophytes compressing the esophagus and interfering with multiple components of swallow, contributing to frank aspiration of thickened liquids. Evaluation by otolaryngology revealed large bulging of posterior pharynx confirmed on computed tomography to be large bridging anterior cervical osteophytes at C2-3, C3-4, C4-5 and C5-6. He ultimately underwent C2-6 anterior cervical osteophytectomy to relieve obstruction.

Setting: Tertiary care hospital

Patient: 57-year-old male with necrotizing pancreatitis.

Assessment/Results: Patient experienced rapid improvement in swallow and was upgraded to a regular diet shortly after surgery. Unfortunately, he suffered another bowel anastomotic leak requiring nothing by mouth and resumption of TPN.

Discussion: DISH is most commonly seen in the thoracolumbar spine region of older males. There are several cases involving the cervical spine, but few with mechanical obstruction causing oropharyngeal dysphagia. It is possible that multiple intubations and episodes of nasogastric tube placement contributed to pharyngeal irritation and edema, leading to diagnosis of DISH. Surgical resection is typically successful in relieving pharyngeal obstruction, reducing symptoms and aspiration risk.

Conclusion: Anterior cervical osteophytes due to DISH can cause symptomatic obstructive dysphagia, but patients tend to have rapid recovery and symptoms improvement following surgical osteophytectomy.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/incidental-diffuse-idiopathic-skeletal-hyperplasia-dish-and-anterior-cervical-osteophytes-causing-severe-oropharyngeal-dysphagia-a-case-report/