ABSTRACT

Iatrogenic esophageal perforation occurs rarely in neonates and was first reported in the literature by Eklof and colleagues. Esophageal perforation in newborns can be classified as iatrogenic or noniatrogenic. Noniatrogenic perforations are extremely rare and are usually seen in full-term infants when they occur. Distal esophageal perforation may be associated with dilatation of an esophageal stricture secondary to esophagitis, a technical error during antireflux surgery, or a misplaced gastrostomy balloon. Newborns with iatrogenic esophageal injury may demonstrate excessive salivation and mucoid secretions due to difficulty swallowing, and many will have overt respiratory distress. In premature infants, the presence of blood-tinged oral secretions after endotracheal intubation warrants serial x-ray examinations of the chest. Esophagoscopy is usually not indicated at the time of diagnosis and may actually enlarge the perforation. Iatrogenic perforation of the esophagus is more common than reported in the literature and may be fatal without early diagnosis.