ABSTRACT
Accidental perforation of the esophagus and the hypopharynx occurs rarely in newborn infants despite numerous instrumentation, including intubation of the esophagus, pharynx and airway. Iatrogenic perforation of the esophagus in neonates was first reported in the literature in 1969 by Eklof and colleagues.1 In the past decade, perforation of the esophagus in premature infants has been increasingly recognized and reported. Spontaneous perforation of the esophagus in neonates (neonatal Boerhaave’s syndrome) is extremely rare, and Fryfogle reported the first successful repair.2 Esophageal perforation may be fatal without early diagnosis, and delayed treatment causes an increase in morbidity and mortality.3,4
Esophageal perforation in newborns can be classified as iatrogenic or non-iatrogenic. Non-iatrogenic perforations are extremely rare, and are usually seen in full-term infants when they do occur. The most common site of perforation is the lower end of the esophagus. Etiological hypotheses for spontaneous perforation vary and include increased abdominal pressure at delivery, perinatal hypoxemia, peptic esophagitis and gastro-esophageal reflux.5-8
Iatrogenic perforation of the esophagus is more commonly seen in premature, small for gestational age (SGA) infants9 and usually occurs in the cervical esophagus. Pharyngeal suctioning with a stiff catheter, endotracheal intubation, traumatic laryngoscopy and digital manipulation of the infant’s head during breech delivery have all been described as etiological factors.10
Esophageal dilatation, intraoperative technical error and postoperative anastomotic leak are potential iatrogenic surgical causes.11,12
