Esophageal Perforation During Dilation in a Patient With Hypopharyngeal Metastatic Squamous Cell Carcinoma.

We report the case of a 75-year-old female with a history of stage IVa hypopharyngeal squamous cell carcinoma who presented with dysphagia due to cervical esophageal stricture after prior laryngopharyngectomy and cervical esophagectomy. During rigid pharyngeal dilation, an acute and uncontained cervical esophageal perforation involving the superior mediastinum occurred, leading to pneumomediastinum. This was immediately complicated by her surgically altered anatomy creating bilateral pneumothoraces, tension pneumoperitoneum, and subsequent hemodynamic instability. Prompt recognition and emergent intervention, including needle decompression, chest tube placement, exploratory laparotomy, and intensive postoperative care, stabilized the patient's condition. This case highlights the challenges in managing high-risk patients with complex airway and esophageal conditions, underscoring the importance of multidisciplinary coordination and rapid response in preventing fatal outcomes.