Passage of feeding catheters into the pleural space: a radiographic sign of trauma to the pharynx and esophagus in the newborn

Complications of Gastrointestinal Intubation

“…Lucaya et al (35) have analyzed the clinical and radiographic features of such trauma in 31 neonates and infants. Four other examples manifested by extraluminal passage of feeding tubes into the pleural space were described by Kassner et al (18). Perforation of the hypopharynx or cervical esophagus of adult patients during routine intestinal intubation is rather unusual.…”

“…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).…”

“…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.…”

Esophageal perforation in the newborn

“…Spontaneous perforations affect the distal portion of the esophagus and are considered to be a n a t o m i c a l defects, or they are due to intrinsic dysfunction o f the esophagus which are often initiated by esophagitis [5]. Catheters used for removing secretions or for naso-gastric feeding have been the cause of almost all the traumatic perforations of the esophagus [2,3,5,7]. Extremely rare cases have been r e p o r t e d where perforation has been caused during laryngoscopy [9] or after introduction of a finger into the m o n t h to perform fetal extraction during breech delivery [4].…”

“…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.…”