Spontaneous rupture of the esophagus in the newborn

Abstract

Two cases of neonatal spontaneous rupture of the esophagus are described, one of which is associated with a duodenal stenosis. Seventeen cases have been reported. They present clinically with non-specific signs of respiratory insufficiency and radiologically by a right-sided hydropneumothorax. Esophageal opacification shows a leak above the diaphragm. A sudden increase in esophageal pressure at birth is considered to be a major etiologic factor leading to rupture. The presence of a duodenal obstruction support this hypothesis.

Hydropneumothorax in a neonate caused by esophageal rupture with duodenal obstruction

“…All patients were delivered vaginally, and three had hydramnios. Two cases were diagnosed with Down syndrome 4 . In all cases, abdominal distension and/or respiratory distress associated with hematemesis were observed within a few hours after delivery.…”

“…Treatment strategy for this lethal condition is still controversial. In the early three cases, direct closures were performed but two died of sepsis after surgery 2–4 . Currently, pleural drainage, gastric decompression and broad‐spectrum antibiotics is essential for the initial treatment.…”

“…Two cases were diagnosed with Down syndrome. 4 In all cases, abdominal distension and/or respiratory distress associated with hematemesis were observed within a few hours after delivery. All patients developed right-sided hydropneumothorax within the first day of life.…”

“…In the early three cases, direct closures were performed but two died of sepsis after surgery. [2][3][4] Currently, pleural drainage, gastric decompression and broad-spectrum antibiotics is essential for the initial treatment. In the present case, the closure of the fistula was successfully achieved with debridement and drainage by video-assisted thoracoscopic surgery (VATS) and continuous suction of the gastric tube.…”

“…1,2 There have been four case reports of infants with spontaneous rupture of the esophagus, associated with duodenal atresia/stenosis. [2][3][4][5] All patients were delivered vaginally, and three had hydramnios. Two cases were diagnosed with Down syndrome.…”