Unusual site for oesophageal perforation in an extremely low birth weight infant

A male infant born at 26 weeks gestation became unwell at 10 days of age wi th blood-stained pharyngeal aspirates. The chest radiograph revealed a feed ing tube in the right pleural cavity, indicating a perforation of the thora cic oesophagus. The infant had had a chest drain inserted on the right side on two previous occasions. These had been allowed to remain across the med iastinum at the site of the subsequent perforation. The infant was successf ully managed conservatively with no long-term sequelae The unusual site of the perforation led us to conclude that pressure necrosis from the drains w as a contributing factor in the aetiology. Conclusion Oesophageal perforations in the neonate, in contrast to the adul t, can be managed conservatively.