Oesophageal perforation presenting as oesophageal atresia in a premature neonate following difficult intubation

Iatrogenic oesophageal perforation in neonates is well recognized in the medical and surgical literature with intubation injury listed as a possible contributing mechanism besides nasogastric tube placement and suctioning. Diagnosis can be difficult and sometimes confused with other entities. With e...

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Bibliographic Details
Published in:Pediatric anesthesia 2001-01, Vol.11 (1), p.112-118
Main Authors: Seefelder, C., Elango, S., Rosbe, K.W., Jennings, R.W.
Format: Article
Language:English
Subjects:
anaesthesia
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Diagnosis, Differential
Diagnostic Errors
Esophageal Atresia - diagnosis
Esophageal Perforation - diagnosis
Esophageal Perforation - etiology
Esophagoscopy
General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation
Humans
Infant, Newborn
Infant, Premature, Diseases - diagnosis
Intubation, Gastrointestinal - adverse effects
Intubation, Intratracheal - adverse effects
intubation: difficult intubation
Laryngoscopy
Male
Medical sciences
neonate
oesophageal perforation
Pharynx - injuries
Pierre Robin Syndrome
Radiography, Thoracic
Tracheoesophageal Fistula - diagnosis
tracheo–oesophageal fistula
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Summary:Iatrogenic oesophageal perforation in neonates is well recognized in the medical and surgical literature with intubation injury listed as a possible contributing mechanism besides nasogastric tube placement and suctioning. Diagnosis can be difficult and sometimes confused with other entities. With early diagnosis, nonsurgical management often leads to complete resolution in neonates. We report the case of a 1‐day‐old premature neonate who was brought to the operating room with the preliminary diagnosis of proximal oesophageal atresia with stump perforation and distal tracheo‐esophageal fistula. His intubation for respiratory distress at birth had been difficult due to Pierre–Robin sequence with micrognathia. Oesophagoscopy in the operating room revealed a patent oesophagus but perforations in the pharynx and in the proximal oesophagus with the nasogastric tube entering the pharyngeal perforation. Oesophageal perforation and the limitations of the difficult airway algorithm in small neonates are discussed.
ISSN:1155-5645
1460-9592
DOI:10.1046/j.1460-9592.2001.00591.x