An 18 day old infant was referred with right pyothorax secondary to distal esophageal perforation. Drainage of the thoracic cavity had been done by a referring pediatrician. After admission a gastrostomy was created for duodenal tube feeding and she was successfully managed. The subsequent upper gastrointestinal X-ray series revealed no leakage at the distal part of the esophagus, but a gastroesophageal reflux was found. Twenty-four-hour pH monitoring of the distal esophagus was carried out. A reflux of the gastric juice into the distal esophagus was present when the patient strained. A combined procedure of fundplication and gastropexy with a repair of esophageal perforation was performed. The pH monitorihg of the esphagus performed after operetion showed no evidence of reflux. This paper summarizes our experience with this patient inducing the etiological consideration of neonatal esophageal perforation and discusses the appraisal of pH monitoring for gastroesophageal reflux.
