Esophageal Perforation in the Neonate

Abstract

The clinical and roentgenographic findings in traumatic esophageal perforation in the newborn are specific enough to enable a diagnosis to be made rapidly. A case of this entity is discussed and the literature on this subject is reviewed. This case demonstrates that the diagnosis can be strongly suspected from the findings on the chest roentgenogram and confirmed by performing an esophagram.

Complications of Gastrointestinal Intubation

“…In newborn infants pharyngoesophageal perforations can occur during insertion of nasogastric tubes or suctioning of oral and upper-airway secretions (14,(17)(18)(19) (Fig. 3-3).…”

“…The tip of tube may be engaged in the pyriform sinus or cause mucosal outpouching posteriorly just above the cricopharyngeus muscle. A type of "crush injury" with perforation may ensue as a result of compression of the posterior pharyngoesophageal wall against the cervical spine (19,38). The extraluminal protrusion ofthe tube can create a false passage into the posterior mediastinum or even the retroperitoneal space (18,19).…”

“…A type of "crush injury" with perforation may ensue as a result of compression of the posterior pharyngoesophageal wall against the cervical spine (19,38). The extraluminal protrusion ofthe tube can create a false passage into the posterior mediastinum or even the retroperitoneal space (18,19). The created sinus tract or pharyngeal pseudodiverticulum often closely resembles an esophageal duplication or a true pharyngeal diverticulum when opacified with contrast material (14,17,35) (Figs.…”

“…Esophagography, endoscopy, or both may be used to identify the exact location of perforation before surgical closure or drainage is attempted. Several authors have advocated conservative treatment of traumatic pharyngeal pseudodiverticulum in infants, reserving surgery for cases further complicated by mediastinitis, cervical abscess, or pneumopericardium with cardiac tamponade (19,35,40,41).…”

Esophageal perforation in the newborn

“…Esophageal p e r f o r a t i o n during the neonatal period is a rare iatrogenic c o m p l i c a t i o n which due to its rapid evolution and relatively high mortality must be diagnosed early [2,5,7]. The presentation of complex, nonspecific clinical and r a d i o g r a p h i c signs and the unc o m m o n e s s of this condition m a k e the p r o p e r diagnostic a p p r o a c h and subsequent choice of therapy especially critical.…”