Intubation perforation of the oesophagus in the newborn baby

Abstract

Two identical newborn twins, weighing 1·75 and 1·8 kg, were admitted to hospital for exchange transfusion for rhesus incompatibility. In both children there was difficulty in passing a stomach tube for feeding purposes and it was noticed that an excessive amount of mucus was produced from the mouth. Therefore contrast swallow examinations were performed and a diagnosis of double oesophagus was made in both twins. They were transferred to The Children's Hospital at the age of two days. Repeat contrast examination in Twin I showed disturbed pharyngeal movements, with some upwards passage into the nasopharynx and some spill into the trachea, but normal transit through the oesophagus. At the junction of the pharynx and oesophagus, contrast medium entered a vertical channel running behind the oesophagus and ending blindly at the level of T3–4 (Fig. 1). Twin II showed similar appearances, again with disturbance of pharyngeal movements and over-spill into the trachea. In this baby the posterior channel was longer, passing downwards vertically in a straight line through the diaphragm to end in an irregular posterior abdominal cavity (Fig. 2). The channel, which was easily intubated during fiuoroscopy, diverged from the oesophagus at its lower end and did not show the normal terminal obliquity to the left of the latter organ. The main initial problems were the rhesus incompatibility and the general condition of the babies.