Oesophageal perforation in extreme prematurity.

Management of oesophageal perforation in extremely premature babies is a challenge and carries a high morbidity. The authors report their experience of three separate cases of oesophageal perforation they encountered over the last 18 months in extremely premature neonates. In the first case, the diagnosis of oesophageal perforation was known in an otherwise stable baby who was treated conservatively with a good outcome. In the second and third cases, the patients proceeded to thoracotomy before the diagnosis of a perforated oesophagus was unveiled. A subsequent diagnosis of trisomy 18 and complex cardiac anomalies in the second case proved incompatible with life and treatment was withdrawn. In the final case, an oesophagostomy was fashioned with a gastrostomy for feeding postoperatively and gastric interposition is planned later this year.