Case Report on Esophageal Perforation in a Neonate from Congenital Web Rupture

Abstract

Background: Esophageal perforation in neonates is an uncommon but potentially fatal condition, most often associated with iatrogenic injury or congenital anomalies. Congenital esophageal webs are rare and may remain asymptomatic until disrupted, leading to acute complications. Awareness of such rare etiologies is critical for early diagnosis and appropriate management.

Case Presentation: The author reports the case of a term neonate who presented with excessive drooling, choking during feeds, and progressive respiratory distress. Radiographic evaluation revealed mediastinal air and contrast extravasation, consistent with a distal esophageal perforation. Further imaging identified a thin congenital esophageal web proximal to the perforation site, suggesting rupture as the underlying cause. The infant remained hemodynamically stable with a contained leak.

Nursing Intervention: Key nursing interventions included strict cessation of oral feeding, continuous monitoring of respiratory status, nasogastric decompression, administration of intravenous antibiotics, and initiation of parenteral nutrition. Nurses played a central role in monitoring for signs of sepsis, maintaining fluid and nutritional balance, and providing supportive care while minimizing further esophageal instrumentation.

Outcome: The infant was managed conservatively following multidisciplinary evaluation. Over several weeks, clinical symptoms resolved, and follow-up imaging demonstrated complete healing of the esophageal perforation without the need for surgical intervention.

Conclusion: This case highlights rupture of a congenital esophageal web as a rare cause of neonatal esophageal perforation. Nonspecific initial symptoms can delay diagnosis, underscoring the importance of early imaging and clinical vigilance. Conservative management, supported by meticulous nursing care and multidisciplinary collaboration, can result in excellent outcomes in selected cases. Clinicians should consider congenital esophageal anomalies in neonates presenting with persistent feeding difficulties and unexplained respiratory distress.