Tracheal Rupture Secondary to an Iatrogenic Esophageal Perforation Presenting with Neck Insufflation on Valsalva: A Case Report

Background: Tracheal rupture is a rare, life-threatening condition that may follow blunt trauma, intubation, and, less commonly, esophageal instrumentation. The diagnosis may be challenging due to the subtle, delayed, and wide variety of symptoms. We present a unique case of delayed tracheal rupture secondary to iatrogenic esophageal perforation, presenting months later with a cervical neck insufflation on Valsalva, a novel clinical sign that has not been previously described in the literature. Case Presentation: A 44-year-old male initially presented with esophageal food impactation. Following endoscopic removal attempts, he developed signs consistent with esophageal perforation and was managed conservatively. In follow-up, he reported persistent neck discomfort, facial numbness, and the ability to insufflate the right side of his neck while doing a Valsalva. Flexible bronchoscopy and retrospective review of imaging revealed a proximal posterior tracheal defect, initially misinterpreted as a tracheal diverticulum. Surgical exploration confirmed a 6 cm dehiscence between the membranous trachea and the anterior wall of the esophagus. The defect was repaired using regional muscle flaps with tissue sealant reinforcement. Postoperatively, the patient had complete symptom resolution and no recurrence of neck insufflation. Conclusions: The case underscores the importance of maintaining a high index of suspicion for tracheal injury in patients with persistent or atypical symptoms following esophageal perforation or instrumentation. To our knowledge, we have described a novel clinical finding of neck insufflation upon Valsalva for diagnosing tracheal rupture.