INFLICTED ESOPHAGEAL-PERFORATION

Esophageal perforation in children is uncommon. A 21/2-yearold girl pr esented with multiple soft tissue injuries of various chronological ag es. Initial lateral cervical spine films showed the presence of a prev ertebral air collection with soft tissue swelling. Enhanced computeriz ed tomography confirmed the presence of proximal esophageal rupture an d a retropharyngeal abscess. External drainage of the abscess and intr avenous antibiotics led to resolution of the perforation in 13 days. D iscrepancies in the history and the constellation of injuries pointed to an inflicted etiology (through child abuse). Since 1984, 21 case st udies have described inflicted esophageal perforation. Common mechanis ms of injury include foreign body ingestion and blunt or penetrating e xternal trauma. Early diagnosis of these injuries reduces both acute a nd long-term morbidity and mortality. Pediatric surgeons must be aware of inflicted injury as an etiology of esophageal and hypopharyngeal p erforation. Copyright (C) 1998 by W.B. Saunders Company.