Journal of the Chinese Medical Association
Volume 70, Issue 4 , Pages 171-175, April 2007

Endoscopic Diagnosis and Management of Iatrogenic Cervical Esophageal Perforation in Extremely Premature Infants

  • Wen-Jue Soong

      Affiliations

    • Corresponding Author InformationCorrespondence to: Dr Wen-Jue Soong, Department of Pediatrics, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.

Department of Pediatrics, Taipei Veterans General Hospital, and Institute of Emergency and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.

Received 23 August 2006; accepted 8 February 2007.

Article Outline

Blind oro-(naso)-pharyngeal suction and feeding catheter intubation are very common practices in pediatric critical care. However, these simple procedures may produce unexpected complications in friable tiny patients. We encountered 3 extremely premature infants in whom cervical esophageal perforation and further submucosal excavation were caused by traumatic catheter injury and subsequently led to catastrophes. These episodes of iatrogenic trauma were all successfully diagnosed early, documented and managed with the aid of ultrathin flexible endoscopy.

Key Words:  endoscopy , iatrogenic esophageal perforation

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References 

  1. Johnson DE , Foker J , Munson DP , Nelson A , Athinarayanan P , Thompson TR . Management of esophageal and pharyngeal perforation in the newborn infant . Pediatrics . 1982;70:592–596
  2. Cairns PA , MeClure BG , Halliday HL , Reid MM . Unusual site for oesophageal perforation in an extremely low birth weight infant . Eur J Pediatr . 1999;158:152–153
  3. Kras JF , Marchmont-Robison H . Pharyngeal perforation during intubation in a patient with Crohn's disease . J Oral Maxillofac Surg . 1989;47:405–407
  4. Panieri E , Millar AJW , Rode H , Brown RA , Cywes S . Iatrogenic esophageal perforation in children: patterns of injury, presentation, management, and outcome . J Pediatr Surg . 1996;31:890–895
  5. Engum SA , Grosfeld JL , West KW , Rescorla FJ , Scherer LRT , Vaughan WG . Improved survival in children with esophageal perforation . Arch Surg . 1996;131:604–611
  6. Lind LJ , Wallace DH . Submucosal passage of a nasogastric tube complicating attempted intubation during anesthesia . Anesthesiology . 1978;49:145–147
  7. Yang JF, Soong WJ, Jeng MJ, Chen SJ, Lee YS, Tsao PC, et al  Esophageal atresia with tracheoesophageal fistula: ten years of experience in an institute . J Chin Med Assoc . 2006;69:317–321
  8. Huang IF , Wu TC , Wang KS , Hwang B , Hseih KS . Upper gastrointestinal endoscopy in children with upper gastrointestinal bleeding . J Chin Med Assoc . 2003;66:271–275
  9. Jaile JC , Levin T , Wung JT , Abramson SJ , Ruzal-Shapiro C , Berdon WE . Benign gaseous distension of the bowel in premature infants treated with nasal continuous airway pressure: a study of contributing factors . AJR Am J Roentgenol . 1992;158:125–127
  10. Girdany BR , Sieber WK , Osman MZ . Traumatic pseudodiverti-culums of the pharynx in newborn infants . N Engl J Med . 1969;280:237–240
  11. Durand M , Sardesai S , McEvoy C . Effect of early dexamethasone therapy on pulmonary mechanics and chronic lung disease in very low birth weight infants: a randomized controlled trial . Pediatrics . 1995;95:584–590
  12. Yeh TF , Torre JA , Rastogi A , Anyebuno MA , Pildes RS . Early postnatal dexamethasone therapy in premature infants with severe respiratory distress syndrome: a double-blind, controlled study . J Pediatr . 1990;117:273–282
  13. Rastogi A , Akintorin SM , Bez ML , Morales P , Pildes RS . A controlled trial of dexamethasone to prevent bronchopulmonary dys-plasia in surfactant-treated infants . Pediatrics . 1996;98:204–210
  14. Baxter JD , Forsham PH . Tissue effects of glucocorticoids . AJR Am J Med . 1972;53:573
  15. Fauci AS . Glucocorticosteroid therapy . In:  Wyngaarden JB ,  Smith LH editor. 2. Cecil's Textbook of Medicine . 1: Philadelphia: WB Saunders; 1985;p. 111–116
  16. Han SY , McElvein RB , Aldrete JS , Tishler JM . Perforation of the esophagus: correlation of site and cause with plain film findings . AJR Am J Roentgenol . 1985;145:537–540
  17. Wychulis AR , Fontana RS , Payne WS . Instrumental perforation of the esophagus . Chest . 1969;55:184–189
  18. Jones WG , Ginsberg RJ . Esophageal perforation: a continuing challenge . Ann Thorac Surg . 1992;53:534–543
  19. Bladergroen MR , Lowe JE , Postlethwalt RW . Diagnosis and recommended management of esophageal perforation and rupture . Ann Thorac Surg . 1986;42:235–239
  20. Sarr HG , Pemberton JH , Payne WS . Management of instrumental perforations of the esophagus . J Thorac Cardiovasc Surg . 1982;84:211–218
  21. Soong WJ , Jeng MJ , Hwang B . The application of a modified mini-flexible-fiberoptic-endoscopy in pediatric practice . J Chin Med Assoc . 1995;56:338–344
  22. Lee YS , Soong WJ . Flexible endoscopy of aerodigestive tract in small infants . Pediatr Int . 2003;45:530–533
  23. Shockley WW , Tate JL , Stucker FJ . Management of perforation of the hypopharynx and cervical esophagus . Laryngoscope . 1985;95:939–941
  24. Levine PA . Hypopharyngeal perforation: an untoward complication of endotracheal intubation . Arch Otolaryngol . 1980;106:578–580
  25. Dolgin SR , Kumar NR , Wykoff TW . Conservative medical management of pharyngeal perforation . Ann Otol Rhinol Laryngol . 1992;101:209–215

PII: S1726-4901(09)70352-1

doi:10.1016/S1726-4901(09)70352-1

Journal of the Chinese Medical Association
Volume 70, Issue 4 , Pages 171-175, April 2007

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