Esophageal Perforation in the Newborn

  • David S. FoleyEmail author
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Esophageal perforations in newborns can occur for a multitude of reasons and are best classified as iatrogenic or spontaneous. Spontaneous perforation is extremely rare and more commonly encountered in full-term infants. Iatrogenic perforations are more often seen in premature, small for gestational age infants and usually occur in the cervical esophagus or hypopharynx. Frequent causes for iatrogenic perforation include pharyngeal suctioning, laryngoscopy, attempted esophageal intubation, and digital manipulation of the neonatal head during breech delivery.

With early diagnosis and close monitoring, even more distally located iatrogenic perforations can often be managed conservatively with good outcomes. Early diagnosis of this condition allows for further surgical treatment options such as closed-chest drainage, primary repair, or stenting. Delayed diagnosis may result in the inability to repair the injury primarily, a significant increase in mortality, and the eventual need for esophageal replacement among survivors.


Esophageal perforation Boerhaave’s syndrome Cervical esophagus Hypopharynx Hydropneumothorax Pneumomediastinum Esophagography Thoracostomy 


  1. Aaronson IA, Cywess S, Louwh JH. Spontaneous esophageal rupture in the newborn. J Pediatr Surg. 1975;10:459.CrossRefGoogle Scholar
  2. Ahmad A, Wong Kee Song LM, Absah I. Esophageal stent placement as a therapeutic option for iatrogenic esophageal perforation in children. Avicenna J Med. 2016;6(2):51–3.CrossRefGoogle Scholar
  3. Astley R, Roberts KD. Intubation perforation of the esophagus in the newborn baby. Br J Radiol. 1970;43:219.CrossRefGoogle Scholar
  4. Blair GK, Filler RM, Theodorescu D. Neonatal pharyngoesophageal perforation mimicking esophageal atresia: clues to diagnosis. J Pediatr Surg. 1987;22:270.CrossRefGoogle Scholar
  5. Cairns PA, McClure BG, Halliday HL, et al. Unusual site for oesophageal perforation in an extremely low birth weight infant. Eur J Pediatr. 1999;158:152–3.CrossRefGoogle Scholar
  6. Ducharme JC, Bertrano R, Debie J. Perforation of the pharynx in the newborn: a condition mimicking esophageal atresia. Can Med Assoc J. 1971;104:785.PubMedPubMedCentralGoogle Scholar
  7. Eklof O, Lohr G, Okmian L. Submucosal perforation of the esophagus in the neonate. Acta Radiol. 1969;8:1987.Google Scholar
  8. Engum SA, Grosfeld JL, West KW, et al. Improved survival of children with esophageal perforation. Arch Surg. 1996;131:604–11.CrossRefGoogle Scholar
  9. Eraklis AJ, Gross RE. Esophageal atresia: management following an anastamotic leak. Surgery. 1966;60:919.PubMedGoogle Scholar
  10. Fryfogle JD. Discussion of Anderson RL. Rupture of the esophagus. J Thorac Cardiovasc Surg. 1952;24:369–88.Google Scholar
  11. Gander JW, Berdon WE, Cowles RA. Iatrogenic esophageal perforation in children. Pediatr Surg Int. 2009;25(5):395–401.CrossRefGoogle Scholar
  12. Garey CL, Laituri CA, Kaye AJ, et al. Esophageal perforation in children: a review of one instituions experience. J Surg Res. 2010;164(1):13–7.CrossRefGoogle Scholar
  13. Geoghegan SF, Vavasseur C, Donoghue V, Molloy EJ. Easily missed, potentially fatal complication in an extremely preterm infant. BMJ Case Rep. 2014 Jul 22; 2014. pii: bcr2013201397.Google Scholar
  14. Girdany BR, Sieber W, Osman MZ. Pseudodiverticulum of the pharynx in newborn infants. N Engl J Med. 1969;280:237.CrossRefGoogle Scholar
  15. Hesketh AJ, Behr C, Soffer S, et al. Neonatal esophageal perforation: nonoperative management. J Surg Res. 2015;198(1):1–6.CrossRefGoogle Scholar
  16. Johnson DE, Foker J, Munson DP, et al. Management of esophageal and pharyngeal perforation in the newborn. Pediatrics. 1982;70:592–9.PubMedGoogle Scholar
  17. Johnson JF, Wright DR. Chest tube perforation of esophagus following repair of esophageal atresia. J Pediatr Surg. 1990;25:1227.CrossRefGoogle Scholar
  18. Kairamkonda VR. A rare cause of chylopneumothorax in a preterm neonate. Indian J Med Sci. 2007;61(8):476–7.CrossRefGoogle Scholar
  19. Krasna IH, Rosenfield D, Benjamin BG, et al. Esophageal perforation in the neonate: an emergency problem in the newborn nursery. J Pediatr Surg. 1987;227:784.CrossRefGoogle Scholar
  20. Lee S, Kuhn JP. Esophageal perforation in the neonate. Am J Dis Child. 1976;130:325.CrossRefGoogle Scholar
  21. Michael L, Grillo HC, Malt RA. Operative and nonoperative management of esophageal perforations. Ann Surg. 1981;194:57.CrossRefGoogle Scholar
  22. Mileder LP, Müller M, Reiterer F, et al. Esophageal perforation with unilateral fluidothorax caused by nasogastric tube. Case Rep Pediatr. 2016;2016:4103734. Epub 2016 Oct 10.PubMedPubMedCentralGoogle Scholar
  23. Miller JW, Hart CK, Statile CJ. Oesophageal perforation in a neonate during transesophageal echocardiography for cardiac surgery. Cardiol Young. 2015;25(5):1015–8.CrossRefGoogle Scholar
  24. Mollit DC, Schullinger JW, Santulli T. Selective management of iatrogenic esophageal perforation in the newborn. J Pediatr Surg. 1981;16:989.CrossRefGoogle Scholar
  25. Mukerideen-Russell IA, Miller-Hance WC, Silverman NH. Unrecognized esophageal perforation in a neonate during transesophageal echocardiography. J Am Soc Echocardiogr. 2001;14(7):747–9.CrossRefGoogle Scholar
  26. Onwuka EA, Saadi P, Boomer LA, et al. Nonoperative management of esophageal perforations in the newborn. J Surg Res. 2016; 205(1): 102–7.CrossRefGoogle Scholar
  27. Ramareddy RS, Alladi A. Review of esophageal injuries and stenosis: lessons learn and current concepts of management. J Indian Assoc Pediatr Surg. 2016;21(3):139–43.CrossRefGoogle Scholar
  28. Rentea RM, St Peter SD. Neonatal and pediatric esophageal perforation. Semin Pediatr Surg. 2017; 26(2): 87–94.CrossRefGoogle Scholar
  29. Rico FR, Panzer AM, Kooros K, et al. Use of Polyflex Airway stent in the treatment of perforated esophageal stricture in an infant: a case report. J Pediatr Surg. 2007;42(7):E5–8.CrossRefGoogle Scholar
  30. Sloan EI, Haight C. Congenital atresia of the esophagus in brothers. J Thorac Surg. 1956;32:200.Google Scholar
  31. Soong WJ. Endoscopic diagnosis and management of iatrogenic cervical esophageal perforation in extremely premature infants. J Chin Med Assoc. 2007;70(4):171–5.CrossRefGoogle Scholar
  32. Su BH, Lin HY, Chiu HY, et al. Esophageal perforation: a complication of nasogastric tube placement in premature neonates. J Pediatr. 2009;154(3):460.CrossRefGoogle Scholar
  33. Urschel Jr HC, Razzuk MA, Wood RE, et al. Improved management of esophageal perforations: exclusion and diversion in continuity. Ann Surg. 1974;179:587.CrossRefGoogle Scholar
  34. Van der Zee DC, Slooff MJH, Kingma LM. Management of esophageal perforations: a tailored approach. Neth J Surg. 1966;38:31.Google Scholar
  35. Wychulis AR, Fontana RS, Payne WS. Instrumental perforation of the esophagus. Chest. 1969;55:184.Google Scholar

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© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Louisville School of MedicineLouisvilleUSA

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