Perforation of the pharynx in the newborn: a near look-alike for esophageal atresia

Iatrogenic esophageal perforation in infants: how to avoid thoracotomy? Two case reports

“…[7,14] Though the same symptoms may be present in esophageal atresia, early recognition of an iatrogenic perforation can avoid unnecessary explorations. [2,[3][4][5][6][7][8][9][10][11][12][13][14][15] Esophagram is not indicated and not even routinely performed before the correction of esophageal atresia. Other evidence as prematurity and low birth weight, forceful and unsuccessful endotracheal intubation, vigorous oropharyngeal suction, and bloody aspirate from the "pouch" is required to be analyzed to raise the surgeon's suspicion of esophageal perforation.…”

“…Plain radiographs can show subcutaneous emphysema, pneumomediastinum, pneumothorax, pleural effusion, and/or lobe atelectasis; a feeding tube located too high or having variable or eccentric positions are unusual findings and very suggestive. [6][7][8][9][10][11][12][13][14][15] The diagnosis can be recognized by esophageal contrast studies under fluoroscopic control, which can demonstrate a classical "double esophagus". [13,14] If contrast-study findings are negative, some radiologic clues mentioned above have to be looked for.…”

“…[6] Spontaneous Esophageal injury in neonates usually occurs at the pharyngoesophageal junction and can be confused with esophageal atresia due to respiratory signs and excessive salivation. [7][8][9][10][11] Diagnostic evaluation and treatment are still debated.…”

Iatrogenic perinatal pharyngoesophageal injury: A disease of prematurity

“…Subsequently, numerous case series have documented additional patients with upper aerodigestive injury following perinatal airway instrumentation; although reported in both term and preterm infants, an overall predilection for premature neonates is evident in the literature [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Reflexive cricopharyngeal muscular constriction and esophageal narrowing and compression against cervical vertebrae with extension of the infant head have been hypothesized to make the posterior hypopharynx and esophageal introitus the site of the vast majority of these injuries [2,3].…”

“…This clinical presentation strongly overlaps with that of esophageal atresia; further differential diagnosis includes pseudodiverticulum and esophageal duplication. Further complicating matters, the superior mediastinal radiolucency typically seen on chest X-ray in patients with pharyngoesophageal perforation is also characteristic of esophageal atresia, leading to misdiagnosis and potentially unnecessary thoracotomy [3,9,[20][21][22]24]. Authors have suggested strategies for differentiating pharyngoesophageal Objective: Perinatal pharyngoesophageal instrumentation, including endotracheal intubation, oral suctioning, and feeding tube placement, is often necessary but risks tissue damage.…”