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Unusual site for oesophageal perforation in an extremely low birth weight infant
P A Cairns1, B G McClure, H L Halliday
1Neonatal Intensive Care Unit, Jubilee Maternity Hospital, Belfast, N. Ireland.
Insights
Neonatal esophageal perforation, though rare, can be successfully treated without surgery. This case highlights conservative management for a thoracic esophageal perforation caused by medical drains in a premature infant.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Gastroenterology
Background:
- Esophageal perforations are a rare but serious complication in neonates.
- Previous interventions, such as chest drain insertion, can predispose infants to esophageal injury.
Observation:
- A premature male infant presented with blood-stained pharyngeal aspirates at 10 days of age.
- Radiographic imaging revealed a feeding tube within the right pleural cavity, indicative of a thoracic esophageal perforation.
- The perforation site was adjacent to previously placed mediastinal chest drains.
Findings:
- The infant's thoracic esophageal perforation was successfully managed conservatively.
- No long-term sequelae were observed following conservative treatment.
- Pressure necrosis from indwelling chest drains is suspected as a contributing factor to the perforation's unusual location.
Implications:
- Conservative management is a viable option for esophageal perforations in neonates, differing from adult treatment protocols.
- Careful consideration of potential complications, such as pressure necrosis, is crucial when managing indwelling medical devices in neonates.
- This case underscores the importance of vigilant monitoring and judicious use of invasive procedures in premature infants.
Unlabelled:
A male infant born at 26 weeks gestation became unwell at 10 days of age with blood-stained pharyngeal aspirates. The chest radiograph revealed a feeding tube in the right pleural cavity, indicating a perforation of the thoracic oesophagus. The infant had had a chest drain inserted on the right side on two previous occasions. These had been allowed to remain across the mediastinum at the site of the subsequent perforation. The infant was successfully managed conservatively with no long-term sequelae The unusual site of the perforation led us to conclude that pressure necrosis from the drains was a contributing factor in the aetiology.
Conclusion:
Oesophageal perforations in the neonate, in contrast to the adult, can be managed conservatively.