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A Unique Cause of Esophageal Perforation in an Infant

Jan, Sheng-Ling∗,†,‡; Chou, Chia-Man‡,§; Wu, Meng-Che∗,†; Lin, Ming-Chih∗,†

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Journal of Pediatric Gastroenterology and Nutrition: May 2020 - Volume 70 - Issue 5 - p e106
doi: 10.1097/MPG.0000000000002457
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A 10-month-old female infant presented with fever for 9 days, poor feeding, and vomiting. A chest radiograph showed a massive pneumomediastinum (Fig. 1). Chest computed tomography showed mediastinitis. Upper gastrointestinal endoscopy revealed esophageal perforation caused by unwitnessed ingestion of a triangular-shaped plastic shred (Fig. 2). Foreign body removal, esophageal repair, and thoracoscopic debridement of the mediastinum were performed. The patient was treated with a 4-week course of antibiotics and was discharged after a 2-month hospitalization.

Chest roentgenogram showed an extensive pneumomediastinum.
A, Upper gastrointestinal endoscopy revealed a triangular-shaped shred of plastic. B, The ingested foreign body was retrieved by endoscopic forceps. This small (about 1 × 1.5 cm) piece of plastic was the tear-off corner of a ketchup packet (C, D, dashed circle).

Esophageal perforation is an uncommon injury in the pediatric population. It is associated with a high morbidity and mortality rate and is life-threatening (1–3). Although rare, foreign body ingestion-related esophageal injuries in infancy are serious and could be caused by something as small as the tear-off corner of a sauce packet, as in the present case. This tiny shred of plastic resulted in an esophageal perforation that led to pneumomediastinum and mediastinal abscess. Physicians and parents alike should be aware of the potential danger of carelessly discarded trash to minimize the risk of foreign body ingestion by infants.


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2. Brinster CJ, Singhal S, Lee L, et al. Evolving options in the management of esophageal perforation. Ann Thorac Surg 2004; 77:1475–1483.
3. Engum SA, Grosfeld JL, West KW, et al. Improved survival in children with esophageal perforation. Arch Surg 1996; 131:604–610.
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