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Pediatric cervical esophageal perforation secondary to abusive blunt thoracic trauma
M A Tavill1, W R Trimmer, M B Austin
1Children's Hospital of Philadelphia, PA, USA.
Insights
Cervical esophageal perforation in infants is rare, often caused by abusive trauma. Early diagnosis is crucial but can be hindered by false information from caretakers, highlighting the need for medical suspicion.
Area of Science:
- Pediatrics
- Trauma Surgery
- Forensic Medicine
Background:
- Cervical esophageal perforation is a rare injury, particularly in infants.
- Blunt force trauma, especially acceleration/deceleration injuries, can cause this severe condition.
- Abusive head trauma is an underrecognized cause of esophageal perforation in infants.
Observation:
- A case study of an 8-week-old infant with cervical esophageal perforation due to abusive acceleration/deceleration trauma is presented.
- The injury was insidious, with diagnosis potentially delayed by falsified historical data from abusive caretakers.
- Challenges in diagnosis include the rarity of the injury and potential obfuscation of events.
Findings:
- Accurate diagnosis and timely intervention are critical for managing esophageal perforation in infants.
- In-depth history taking, meticulous documentation, and reporting to authorities are essential for the medicolegal aspects.
- Pediatricians, emergency department staff, nurses, and otolaryngologists should maintain a high index of suspicion for abuse when encountering esophageal perforation in infants.
Implications:
- This case underscores the importance of recognizing abusive trauma as a cause of esophageal perforation in infants.
- Healthcare providers must be vigilant for non-accidental trauma, even when presented with conflicting or incomplete histories.
- Establishing clear medicolegal protocols is vital for addressing the increasing incidence of abusive injuries in children.
Abstract:
Cervical esophageal perforation secondary to blunt trauma is extremely rare. A case of an 8-week-old infant that sustained a cervical esophageal perforation from abusive acceleration/deceleration blunt trauma is presented. Early diagnosis and appropriate intervention of an already insidious injury can be further delayed by the lack of concise temporal events and falsification of data from the abusive caretaker(s). In-depth history taking, documentation and notification of authorities lays the critical medicolegal groundwork for this unfortunately increasing problem in our society. Diagnosis and management are discussed. The pediatrician, emergency department, nursing staff and otolaryngologist should have strong suspicions of abuse when esophageal perforation is identified in an infant.