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Iatrogenic esophageal perforation in children

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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.

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Authors and Affiliations

  1. Division of Pediatric Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons and Morgan Stanley Children’s Hospital of New York-Presbyterian, New York, NY, 10032, USA

    Jeffrey W. Gander & Robert A. Cowles

  2. Division of Pediatric Radiology, Department of Radiology, Columbia University College of Physicians and Surgeons and Morgan Stanley Children’s Hospital of New York-Presbyterian, New York, NY, 10032, USA

    Walter E. Berdon

Authors
  1. Jeffrey W. Gander
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  2. Walter E. Berdon
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  3. Robert A. Cowles
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Correspondence to Robert A. Cowles.

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Gander, J.W., Berdon, W.E. & Cowles, R.A. Iatrogenic esophageal perforation in children. Pediatr Surg Int 25, 395–401 (2009). https://doi.org/10.1007/s00383-009-2362-6

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