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Eguchi S, Hisaeda Y, Ukawa T, Koto M, Hosokawa M, Tsurisawa C, Takeda T, Amagata S, Nakao A. Clinical Features of iatrogenic Pharyngo-esophageal perforation in very low birth weight infants. Pediatr Neonatol 2024:S1875-9572(24)00072-X. [PMID: 38769031 DOI: 10.1016/j.pedneo.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/10/2023] [Accepted: 11/27/2023] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Iatrogenic pharyngoesophageal perforation (IPEP) is one of the complications of gastric tube insertion and it tends to occur more frequently in premature infants. Although the frequency is significantly low, attention should be paid as it can lead to serious outcomes with high mortality. This study will help raise awareness with respect to early diagnosis, management, and prevention. METHODS We performed a retrospective cohort study of all very low birth weight infants diagnosed with IPEP between 1993 and 2022. RESULTS A total of 6 patients (0.27% of very low birth weight infants) with the diagnosis of IPEP were included. The median gestational age was 27 + 1 weeks (range 23+5-28 + 6 weeks), and the median birth weight was 823 g (range 630-1232 g). Symptoms included difficulty with gastric tube insertion, bloody secretions in the oral cavity, and increased oral secretions. X-rays revealed aberrant running of the gastric tube in all patients. In three cases, contrast studies demonstrated contrasted mediastinum tapering like a bead. Laryngoscope was used to view the perforation sites but this was not useful in the smallest patient. All patients were treated conservatively with antibiotics and survived. CONCLUSIONS When inserting a gastric tube for premature infants, it is critical to remember that these infants are at risk of IPEP. In addition to a frontal X-ray, a lateral X-ray and contrast study may be useful for early diagnosis.
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Affiliation(s)
- Shu Eguchi
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.
| | - Yoshiya Hisaeda
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Toshiko Ukawa
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Mayu Koto
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Miku Hosokawa
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Chisa Tsurisawa
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Tomohiro Takeda
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Shusuke Amagata
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Atsushi Nakao
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
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Borries T, Eldore LW, Burris J, Shah Z, Ford K. Esophageal Perforation of a Neonate Following Placement of an Oral Gastric Tube. Cureus 2023; 15:e44461. [PMID: 37791196 PMCID: PMC10544182 DOI: 10.7759/cureus.44461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
We present a case of neonatal esophageal perforation following routine oral gastric (OG) tube placement in the neonatal intensive care unit. This is a rare complication primarily affecting premature infants and can have significant morbidity and mortality. This case demonstrates the initial radiographic presentation of esophageal perforation and the subsequent imaging to confirm the diagnosis. Clinical management of this condition in the neonatal patient is also discussed. A unique highlight of this case is the difference in radiographic presentation on the initial study as compared to the later study.
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Affiliation(s)
- Trevor Borries
- Diagnostic Radiology Residency, Baylor University Medical Center, Dallas, USA
| | - Luke W Eldore
- Medical School, Texas A&M College of Medicine, Dallas, USA
- Radiology, Baylor University Medical Center, Dallas, USA
| | - John Burris
- Radiology, Baylor University Medical Center, Dallas, USA
| | - Zubin Shah
- Radiology, Baylor University Medical Center, Dallas, USA
| | - Kenneth Ford
- Radiology, Baylor University Medical Center, Dallas, USA
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3
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Pharyngo-esophageal complications of Ryle tube insertion in neonates: management and fate. Eur Arch Otorhinolaryngol 2020; 277:3403-3406. [DOI: 10.1007/s00405-020-06160-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 06/18/2020] [Indexed: 11/26/2022]
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Schuman TA, Jacobs B, Walsh W, Goudy SL. Iatrogenic perinatal pharyngoesophageal injury: a disease of prematurity. Int J Pediatr Otorhinolaryngol 2010; 74:393-7. [PMID: 20144485 DOI: 10.1016/j.ijporl.2010.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 01/15/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Perinatal pharyngoesophageal instrumentation, including endotracheal intubation, oral suctioning, and feeding tube placement, is often necessary but risks tissue damage. Our objective was to estimate the incidence of iatrogenic perinatal pharyngoesophageal injury (IPPI) in preterm versus term infants in a children's hospital neonatal intensive care unit (NICU). A secondary goal was to explore the clinical characteristics and outcomes associated with these complications. METHODS All NICU discharge summaries from 2004 to 2008 were searched for IPPI-related keywords. Highlighted records were reviewed and the incidence of complications calculated by gestational age and weight. RESULTS Of 5910 total NICU discharges, 6 cases of IPPI were identified, for an overall incidence of 0.10%. All injuries occurred in infants less than 33 weeks gestational age and 1500g, with a trend towards higher incidence with increasing prematurity. The incidence of IPPI rose to 4/1321 (0.30%) at 27-32 weeks and 2/521 (0.38%) at less than 27 weeks gestation. Similarly, IPPI occurred in 3/675 (0.44%) babies born at 1000-1500g and 3/642 (0.47%) babies below 1000g. All affected infants survived with conservative management. CONCLUSIONS IPPI is a rare but serious complication of perinatal airway instrumentation and is primarily a disease of prematurity. In this sizeable cohort, no complications occurred in term infants, and the incidence of injury increased with decreasing gestational age and weight. This increased propensity towards injury should prompt special care when performing even routine airway procedures on premature neonates.
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Affiliation(s)
- Theodore A Schuman
- Department of Otolaryngology - Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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5
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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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Affiliation(s)
- Jeffrey W Gander
- 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
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Aranda A, Estrada JJ, Petrosyan M, Jackson HA, Stein JE. Neonatal bronchomediastinal fistula. J Pediatr Surg 2007; 42:1792-3. [PMID: 17923219 DOI: 10.1016/j.jpedsurg.2007.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 07/14/2007] [Accepted: 07/17/2007] [Indexed: 11/27/2022]
Affiliation(s)
- Arturo Aranda
- Department of Pediatric Surgery, Children's Hospital Los Angeles, LA, CA 90027, USA.
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7
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Abstract
Obstruction of passage of a catheter through esophagus in a newborn is mostly diagnosed as esophageal atresia (EA) with or without tracheo esophageal fistula (TEF). Rarely a traumatic instrumentation may produce pharyngeal or upper esophageal perforation and attempt at passage of a catheter may produce a false passage submucosally called pseudodiverticulum. Here it is present the case of a extremely premature (28 wk) and low birth weight (950 gms) newborn with traumatic laceration and pharyngeal pseudodiverticulum mimicking EA. The authors discuss the diagnostic characteristics and management of such a situation.
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Affiliation(s)
- Kamalesh Pal
- Department of Pediatric Surgery, Maternity and Children Hospital, Al Ahsa, Saudi Arabia.
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9
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Abstract
Neonatal Boerhaave's syndrome is a rare condition. Most cases are idiopathic. We report a case of neonatal Boerhaave's syndrome associated with duodenal atresia which could have precipitated the former.
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Affiliation(s)
- S K Singh
- Department Pediatric Surgery, Regency Hospital Ltd., Kanpur, India
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Abstract
BACKGROUND Neonatal perforation of the esophagus appears to occur rarely and often can mimic esophageal atresia. This report presents 12 cases of pharyngoesophageal perforation with a review of the literature. PATIENTS From 1980 to 1995, we treated 12 infants for pharyngo-esophageal perforation. Ten infants were pre-term, seven of them weighing less than 1,500 g. Five infants had severe respiratory distress. Four infants had repeated attempt on intubation of the airway and eight infants had a routine postpartum suctioning and gastric aspiration. On plain X-ray, a large right pneumothorax was observed in three cases and the nasogastric tube deviated widely from its expected course in three cases. Four infants underwent contrast esophagography and three infants esophagoscopy. In five cases esophageal atresia was the initial diagnosis. Five infants underwent a thoracotomy. A gastrostomy was performed in one case. The six remaining neonates were treated non-operatively: broad spectrum antibiotics, total parenteral nutrition, and silastic nasogastric tube. Follow-up was uneventful in five cases. One infant with an esophageal stricture underwent instrumental dilatation. Bronchopulmonary dysplasia occurred in two cases and necrotizing enterocolitis in one. Two infants died. CONCLUSION Iatrogenic perforation remains a difficult diagnosis. Clinical findings, plain chest x-ray and oesophagography are helpful. Surgery can be completely avoided in most instances. Infants with low birthweight and prematurity are most at risk.
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Affiliation(s)
- A Bonnard
- Service de chirurgie pédiatrique, hôpital Saint-Vincent-de-Paul, Paris, France
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11
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Krasna IH, Rosenfeld D, Benjamin BG, Klein G, Hiatt M, Hegyi T. Esophageal perforation in the neonate: an emerging problem in the newborn nursery. J Pediatr Surg 1987; 22:784-90. [PMID: 3656033 DOI: 10.1016/s0022-3468(87)80629-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We report 11 cases of esophageal perforation in the neonate, in whom no surgery was performed for repair of the perforation, nor was any cervical or mediastinal drainage carried out. The perforation was in the cervical esophagus in all cases where an esophagram was performed. Nine were in premature babies (580 to 1,350 g), and two were full-term babies. There were two deaths in small prematures (580 and 935 g), from extreme prematurity and intraventricular hemorrhage, with no morbidity or mortality related to the esophageal perforation. The babies presented as esophageal atresia, or pneumothorax with the feeding tube in the right chest, or an abnormal right upper extrapleural air collection with infiltrate. Barium esophagram showed a classic "double esophagus" configuration. Two babies were mistakenly operated on, one with a diagnosis of esophageal duplication, and one had a gastrostomy for a diagnosis of esophageal atresia. Esophageal perforation in the neonate is an iatrogenic disease that may mimic esophageal atresia, and may be managed without surgical intervention.
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Affiliation(s)
- I H Krasna
- Department of Radiology, UMDNJ-Robert Wood Johnson Medical School, New Brunswick 08903
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Kimura K, Kubo M, Okasora T, Eto T, Tsugawa C, Matsumoto Y. Esophageal perforation in a neonate associated with gastroesophageal reflux. J Pediatr Surg 1984; 19:191-3. [PMID: 6726578 DOI: 10.1016/s0022-3468(84)80447-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This is the first report of a neonate with esophageal perforation in whom an association of gastroesophageal reflux (GER) was detected by esophagraphy and esophageal pH monitoring. The patient was successfully treated for both esophageal perforation of GER by thoracic drainage and fundoplication. In this patient, GER seemed a likely cause of esophageal perforation.
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13
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Abstract
Since 1974 nine neonates have been treated for iatrogenic esophageal perforation. They ranged in weight from 480 to 3900 g. Four of them had been resuscitated for meconium aspiration, four were being treated for respiratory distress syndrome (RDS), and one had received only routine postpartum suctioning and gastric aspiration. In five infants, esophageal perforation was suspected following traumatic intubation of difficulty in the passage of a catheter or tube. Three neonates passed formula from chest tubes placed for pneumothorax and one child presented with persistent pneumothorax. Esophageal perforation was documented in each case by direct visualization and/or radiographic studies. Three infants were treated with antibiotics and placement of a silastic nasogastric feeding tube. An additional two infants were treated with a silastic tube, antibiotics and chest tube drainage. Four children underwent operation: gastrostomy and drainage (2), gastrostomy and closure of perforation (1), gastrostomy only (1). There were no complications of deaths. Management of iatrogenic perforation of the esophagus depends upon the extent and location of the injury. A nonoperative approach can be successful in those infants with limited injury of short duration. Operation is required in cases with extensive extravasation or delay in diagnosis.
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15
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Faerber EN, Schwartz AM, Pinch LW, Leonidas JC. Unusual manifestations of neonatal pharyngeal perforation. Clin Radiol 1980; 31:581-5. [PMID: 7471635 DOI: 10.1016/s0009-9260(80)80059-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The small series of previously described cases of neonatal pharyngeal perforation are reviewed and two additional cases with atypical initial presentations are described. The condition is more common than is currently appreciated, as suggested by one of our cases which remained undetected until many years later. We also wish to emphasise the high location of perforation despite an initial presentation which may appear to the contrary.
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16
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Fleming PJ, Venugopal S, Lewins MJ, Martin DJ, Simpson JS. Esophageal perforation into the right pleural cavity in a neonate. J Pediatr Surg 1980; 15:335-6. [PMID: 7381671 DOI: 10.1016/s0022-3468(80)80150-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Right empyema developed, apparently secondary to anterior perforation of the esophagus into the right pleural cavity, in a neonate. Pathogenetic factors and management are discussed.
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17
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Grünebaum M, Horodniceanu C, Wilunsky E, Reisner S. Iatrogenic transmural perforation of the oesophagus in the preterm infant. Clin Radiol 1980; 31:257-61. [PMID: 7428263 DOI: 10.1016/s0009-9260(80)80211-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Traumatic oesophageal perforation may occur during the intensive care of premature infants due to trauma of the laryngoscope blade, to traumatic intubation with an endotracheal tube or to forced passing of a nasogastric tube. Over a four-year period, three infants of 787 admitted to a neonatal intensive care unit were diagnosed as having this complication. The careful analysis of the position of the nasogastric tube in relation to surrounding structures can be an early clue to the diagnosis of this condition.
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Lucaya J, Herrera M, Salcedo S. Traumatic pharyngeal pseudodiverticulum in neonates and infants. Two case reports and review of the literature. Pediatr Radiol 1979; 8:65-9. [PMID: 109805 DOI: 10.1007/bf00973993] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Thirty one cases of pharyngeal pseudodiverticulum have been reported in the literature; twenty nine were diagnosed during the neonatal period. Respiratory distress, increased oral secretions, difficulty with feeding and the impossibility of passing a nasogastric catheter were the most common symptoms and/or signs. Pneumomediastinum, pneumothorax, cervical emphysema and ectopic location of a feeding catheter, alone or in combination, were identified in the chest roentgenograms of 16 patients. Esophagography and/or endoscopy were the diagnostic methods of choice. The exact location of the perforation was identified in 18 patients. Most of the perforations were in either the posterior pharyngeal wall or in the pyriform sinuses. The survival rate was as good amongst the medically treated patients as in those who underwent surgery.
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Kottmeier PK. What the pediatrician should know about pediatric trauma. CURRENT PROBLEMS IN PEDIATRICS 1976; 6:3-55. [PMID: 1277883 DOI: 10.1016/s0045-9380(76)80004-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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