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Iatrogenic Pharyngoesophageal Perforation In The Neonatal Period – Clues For Conservative Treatment

Ognyan Brankov, Hristo Shivachev, Daniela Antonova, Yanko Pahnev.


Introduction: Iatrogenic perforation of the oesophagus in neonates is a rare condition, and it is most frequently seen in low birth weight infants. The commonly reported symptoms of these incidents are sudden onset respiratory distress and failure of endonasal feeding. Our series present an example of difficult nasogastric tube insertion followed by its stoppage at different thoracic levels, and failure to reach the abdomen as well as haemorrhage from the tube lumen. Material and Methods: Five premature infants suspected for the surgical pathology of the oesophagus are retrospectively discussed. Contrast chest X-ray was enough to establish the diagnosis. Clinical observation and intensive care were our first therapeutic method of choice. Results: In two cases the contrast material revealed a contrast depot parallel to the oesophagal lumen up to a point overlying the diaphragm, initially misdiagnosed for tubular duplication of the oesophagus. In another two cases, the contrast X-ray examination showed a normal oesophagal lumen with diverticulum-like enlargement in the upper third, initially misinterpreted as oesophagal atresia. The last case presented with pneumomediastinum and subcutaneous emphysema followed by apnea that required mechanical ventilation. Conclusion: Iatrogenic neonatal pharyngoesophageal perforation (PhEP) is a rare complication in the modern neonatal intensive care. Most cases can be treated conservatively; nevertheless, surgery presents an emergency option in severe cases. The correct interpretation of the X-ray image based on the previous history and clinical symptoms are crucial for the choice of the approach to appropriate treatments.

Key words: iatrogenic pharyngoesophageal perforation, conservative treatment, neonatal surgery

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