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Missed iatrogenic cervical esophageal injury after thyroidectomy is a rare complication. Post-operative painful deglutition, subcutaneous emphysema or local swelling should raise the alarm. Seven days after thyroidectomy, a patient was referred to us with copious purulent discharge and saliva draining from cervical wound. Cervical incision was taken down; wound irrigated and kept open for dressings. Focused wound management along with enteral feeding via feeding jejunostomy was initiated. Esophagoscopy was done in the second week and proximal edge of defect was identified. During the third week, when wound was clean and patient had gained her lost weight back, mucosal and muscular layers were repaired with interposition flap between esophagus and trachea. On seventh post-repair day esophagogram was normal. Patient was discharged on semisolids. Six weeks postoperatively, endoscopy and dilation was done for grade II dysphagia. Six months later, patient remains symptom free.
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