Survival after gastrointestinal perforation from esophageal atresia and tracheoesophageal fistula.

Management of premature infants with esophageal atresia (EA), tracheoesophageal fistula (TEF), and respiratory distress syndrome (RDS) can be one of the most challenging aspects in the surgical care of the newborn. Although not common, there have been reports of EA, TEF, and RDS with gastric perforation, but an associated duodenal perforation has not been reported. Two premature infants weighing less than 1,200 g with EA, TEF, and perforation are described. One baby developed a gastric perforation and the other a duodenal perforation. Emergency thoracotomy and fistula ligation were necessary after gastrostomy placement. These patients are the smallest infants reported to survive gastrointestinal perforation complicated by EA, TEF, and RDS.