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[Traumatic pharyngoesophageal perforation in newborn infants]
A Bonnard1, E Carricaburu, E Sapin
1Service de chirurgie pédiatrique, hôpital Saint-Vincent-de-Paul, Paris, France.
Insights
Neonatal pharyngoesophageal perforation is rare and can mimic esophageal atresia. Early diagnosis using clinical findings, X-rays, and esophagography aids non-operative management, especially in premature infants.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Critical care medicine
Context:
- Pharyngoesophageal perforation is a rare neonatal condition.
- It often presents with symptoms similar to esophageal atresia.
- This study reviews 12 cases and relevant literature.
Purpose:
- To describe the presentation and management of 12 neonates with pharyngoesophageal perforation.
- To identify risk factors and diagnostic challenges.
- To evaluate treatment outcomes and emphasize non-operative management where possible.
Summary:
- Twelve neonates with pharyngoesophageal perforation were treated between 1980 and 1995.
- Risk factors included prematurity, low birthweight, and difficult airway intubation.
- Diagnosis was aided by clinical signs, X-rays, and contrast esophagography; most cases were managed non-operatively.
Impact:
- Highlights the diagnostic difficulties of iatrogenic esophageal perforation in neonates.
- Demonstrates that surgery can often be avoided, with non-operative management being successful in most cases.
- Identifies premature infants and those with low birthweight as high-risk populations, informing preventative strategies.
Background:
Neonatal perforation of the esophagus appears to occur rarely and often can mimic esophageal atresia. This report presents 12 cases of pharyngoesophageal perforation with a review of the literature.
Patients:
From 1980 to 1995, we treated 12 infants for pharyngo-esophageal perforation. Ten infants were pre-term, seven of them weighing less than 1,500 g. Five infants had severe respiratory distress. Four infants had repeated attempt on intubation of the airway and eight infants had a routine postpartum suctioning and gastric aspiration. On plain X-ray, a large right pneumothorax was observed in three cases and the nasogastric tube deviated widely from its expected course in three cases. Four infants underwent contrast esophagography and three infants esophagoscopy. In five cases esophageal atresia was the initial diagnosis. Five infants underwent a thoracotomy. A gastrostomy was performed in one case. The six remaining neonates were treated non-operatively: broad spectrum antibiotics, total parenteral nutrition, and silastic nasogastric tube. Follow-up was uneventful in five cases. One infant with an esophageal stricture underwent instrumental dilatation. Bronchopulmonary dysplasia occurred in two cases and necrotizing enterocolitis in one. Two infants died.
Conclusion:
Iatrogenic perforation remains a difficult diagnosis. Clinical findings, plain chest x-ray and oesophagography are helpful. Surgery can be completely avoided in most instances. Infants with low birthweight and prematurity are most at risk.