ESOPHAGEAL PERFORATION IN NEONATES: A REPORT OF
5 CASES FROM KUWAIT
Al-Sawan RMZ*, Soni AL*, Saleh QA*, Garg KC**
*Dept. of Pediatrics,
**Dept. of Radiology, Farwaniya Hospital, Kuwait
Objective:
Esophageal perforation is not an uncommon occurrence in Neonatal
Intensive Care Units (NICU). The reported incidence is 1 in 5000 Livebirths
(LB).Most of the cases occur in preterm and are traumatic in nature. Upper
Esophageal Perforation (UEP) mimics Congenital Esophageal Atresia while
Lower Esophageal Perforation (LEP) present as right sided pneumothorax and
abnormal position of the Naso-Gastric Tube (NGT). Misdiagnosis can lead to
unnecessary investigations and surgical interference. We report our
experience of 5 such cases from Kuwait.
Methods:
All cases admitted to NICU were carefully examined and investigated for any
evidence of esophageal trauma. Liberal use of radiology done with especial
reference to air-leak and position of the NGT. Surgical advice obtained
wherever needed.
Results:
Total 5 cases were diagnosed, 1 as UEP and 4 as LEP over a period of 5
years among 35700LB, giving an incidence of 1:7140LB. The UEP occurred
immediately after resuscitation and presented as pneumo-mediastinum and
failure to pass the NGT. Diagnosis was confirmed by contrast radiological
study and baby was managed conservatively.The perforation was completely
healed but baby later on died due to other problems. The 4 cases of LEP
presented as sudden pneumothorax on right side and abnormal position of NGT
on day3-5. All cases were managed successfully by conservative treatment;
one died (unrelated toLEP), while remaining 3 done well till 1 year
followup.
Conclusions:
High index of suspicion is needed to diagnose Esophageal Perforation in the
neonates. All NICU staff should be trained and retrained for gentle
resuscitation methods to avoid this complication. Surgical interference is
almost always unnecessary.