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Pediatric Surgery International

, Volume 25, Issue 5, pp 395–401 | Cite as

Iatrogenic esophageal perforation in children

  • Jeffrey W. Gander
  • Walter E. Berdon
  • Robert A. Cowles
Review Article

Abstract

Esophageal perforation is most commonly iatrogenic in origin with nasogastric tube insertion, stricture dilation, and endotracheal intubation, being the most frequent sources of the injury in infants and children. Clinical presentation depends on whether the cervical, thoracic, or abdominal esophagus is injured. Any patient complaining of chest pain after an upper endoscopy has esophageal perforation until proven otherwise. In infants and children, plain chest films and esophagography may assist in making the diagnosis. Hemodynamically stable patients with a contained perforation may be managed medically. Free perforation and hemodynamic lability mandates a more aggressive surgical approach for wide drainage of the mediastinum and pleural spaces. Exploration of the chest for attempted direct repair of the injury is now only rarely indicated. Mortality rates have been reported between 20 and 28% with delays in diagnosis and treatment appearing to be most strongly correlated with poor outcomes.

Keywords

Esophagus Perforation Iatrogenic Atresia 

References

  1. 1.
    Derbes V (1955) a.M., RE, Hermann Boerhaave’s Atrocis, nec Descripti Prius, Morbi Historia, the first translation of the classic case report of rupture of the esophagus, with annotations. Bull Med Libr Assoc 43:217–240PubMedGoogle Scholar
  2. 2.
    Fryfogle J (1952) Discussion of Paper by RL Anderson: Rupture of the Esophagus. J Thorac Surg 24:369–388Google Scholar
  3. 3.
    Engum SA et al (1996) Improved survival in children with esophageal perforation. Arch Surg 131(6):604–610 discussion 611PubMedGoogle Scholar
  4. 4.
    Warden HD, Mucha SJ (1961) Esophageal perforation due to trauma in the newborn. A case report. Arch Surg 83:813–815PubMedGoogle Scholar
  5. 5.
    Mollitt DL, Schullinger JN, Santulli TV (1981) Selective management of iatrogenic esophageal perforation in the newborn. J Pediatr Surg 16(6):989–993. doi: 10.1016/S0022-3468(81)80861-5 PubMedCrossRefGoogle Scholar
  6. 6.
    Panieri E et al (1996) Iatrogenic esophageal perforation in children: patterns of injury, presentation, management, and outcome. J Pediatr Surg 31(7):890–895. doi: 10.1016/S0022-3468(96)90404-2 PubMedCrossRefGoogle Scholar
  7. 7.
    Martinez L et al (2003) Aggressive conservative treatment of esophageal perforations in children. J Pediatr Surg 38(5):685–689. doi: 10.1016/jpsu.2003.50183 PubMedCrossRefGoogle Scholar
  8. 8.
    Blair GK, Filler RM, Theodorescu D (1987) Neonatal pharyngoesophageal perforation mimicking esophageal atresia: clues to diagnosis. J Pediatr Surg 22(8):770–774. doi: 10.1016/S0022-3468(87)80626-7 PubMedCrossRefGoogle Scholar
  9. 9.
    Jones WG 2nd, Ginsberg RJ (1992) Esophageal perforation: a continuing challenge. Ann Thorac Surg 53(3):534–543PubMedGoogle Scholar
  10. 10.
    Fernandez FF et al (1999) Treatment of endoscopic esophageal perforation. Surg Endosc 13(10):962–966. doi: 10.1007/s004649901147 PubMedCrossRefGoogle Scholar
  11. 11.
    O’Neill JA Jr et al (2004) Esophageal rupture and perforation. Principles of pediatric surgery, 2nd edn, pp 405–407Google Scholar
  12. 12.
    Gupta NM, Kaman L (2004) Personal management of 57 consecutive patients with esophageal perforation. Am J Surg 187(1):58–63. doi: 10.1016/j.amjsurg.2002.11.004 PubMedCrossRefGoogle Scholar
  13. 13.
    Peng L et al (2006) Videothoracoscopic drainage for esophageal perforation with mediastinitis in children. J Pediatr Surg 41(3):514–517. doi: 10.1016/j.jpedsurg.2005.11.047 PubMedCrossRefGoogle Scholar
  14. 14.
    Elicevik M et al (2008) Management of esophageal perforation secondary to caustic esophageal injury in children. Surg Today 38(4):311–315. doi: 10.1007/s00595-007-3638-x PubMedCrossRefGoogle Scholar
  15. 15.
    van der Zee DC et al (1988) Management of pediatric esophageal perforation. J Thorac Cardiovasc Surg 95(4):692–695PubMedGoogle Scholar
  16. 16.
    Karnak I et al (1998) Esophageal perforations encountered during the dilation of caustic esophageal strictures. J Cardiovasc Surg (Torino) 39(3):373–377Google Scholar
  17. 17.
    Sapin E et al (2000) Iatrogenic pharyngoesophageal perforation in premature infants. Eur J Pediatr Surg 10(2):83–87. doi: 10.1055/s-2008-1072331 PubMedCrossRefGoogle Scholar
  18. 18.
    Soong W-J (2007) Endoscopic diagnosis and management of iatrogenic cervical esophageal perforation in extremely premature infants. J Chin Med Assoc 70(4):171–175PubMedCrossRefGoogle Scholar
  19. 19.
    Lynch FP et al (1974) Traumatic esophageal pseudodiverticula in the newborn. J Pediatr Surg 9(5):675–681. doi: 10.1016/0022-3468(74)90105-5 PubMedCrossRefGoogle Scholar
  20. 20.
    Pasricha PJ, Fleischer DE, Kalloo AN (1994) Endoscopic perforations of the upper digestive tract: a review of their pathogenesis, prevention, and management. Gastroenterology 106(3):787–802PubMedGoogle Scholar
  21. 21.
    Han SY et al (1985) Perforation of the esophagus: correlation of site and cause with plain film findings. AJR Am J Roentgenol 145(3):537–540PubMedGoogle Scholar
  22. 22.
    Brinster CJ et al (2004) Evolving options in the management of esophageal perforation. Ann Thorac Surg 77(4):1475–1483. doi: 10.1016/j.athoracsur.2003.08.037 PubMedCrossRefGoogle Scholar
  23. 23.
    DeMeester TR (1986) Perforation of the esophagus. Ann Thorac Surg 42(3):231–232PubMedCrossRefGoogle Scholar
  24. 24.
    White RK, Morris DM (1992) Diagnosis and management of esophageal perforations. Am Surg 58(2):112–119PubMedGoogle Scholar
  25. 25.
    Emil SGS (2004) Neonatal esophageal perforation. J Pediatr Surg 39(8):1296–1298. doi: 10.1016/j.jpedsurg.2004.04.033 PubMedCrossRefGoogle Scholar
  26. 26.
    Ajalat GM, Mulder DG (1984) Esophageal perforations. The need for an individualized approach. Arch Surg 119(11):1318–1320PubMedGoogle Scholar
  27. 27.
    Brewer LA 3rd et al (1986) Options in the management of perforations of the esophagus. Am J Surg 152(1):62–69. doi: 10.1016/0002-9610(86)90144-3 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Jeffrey W. Gander
    • 1
  • Walter E. Berdon
    • 2
  • Robert A. Cowles
    • 1
  1. 1.Division of Pediatric Surgery, Department of SurgeryColumbia University College of Physicians and Surgeons and Morgan Stanley Children’s Hospital of New York-PresbyterianNew YorkUSA
  2. 2.Division of Pediatric Radiology, Department of RadiologyColumbia University College of Physicians and Surgeons and Morgan Stanley Children’s Hospital of New York-PresbyterianNew YorkUSA

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