ABSTRACT
Iatrogenic esophageal perforation occurs rarely in neonates
given the repeated orotracheal and oro-esophageal instru-
mentation of these patients, and was first reported in the
literature by Eklof and colleagues.1 In the past two decades,
perforation of the esophagus in extremely premature neo-
nates has become increasingly recognized and reported.
Spontaneous perforation of the esophagus (neonatal Boer-
haave syndrome) is extremely rare, and Fryfogle2 performed
the first successful repair. Despite the favorable results of
non-operative management in cases of neonatal esophageal
perforation, this condition may be fatal without early
diagnosis and treatment, and aggressive surgical therapy is
occasionally warranted.35 Surgeons must continue to play a
central role in the individualization of care in these patients.
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 occur. The most common site of perforation is the lower
third of the esophagus. Etiological hypotheses for sponta-
neous perforation include increased intra-abdominal pres-
sure at delivery, perinatal hypoxemia, and reflux-associated
peptic esophagitis.6
