Iatrogenic esophageal perforation has been increasingly recognized as a complication of modern neonatal resuscitation occurring most frequentry in the premature infants. It usually results from endotracheal intubation, vigorous oropharyngeal suctioning or the passage of a nasogastric tube. The clinical and roentgenographic findings in this condition can mimic esophageal atresia or esophageal duplication. Two cases which were misdiagnosed as esophageal duplication are reported. Case 1 is an infant with submucosal penetration of the esophagus because of vigorous oropharyngeal suctioning after birth. An esophagogram demonstrated a classic "double esophagus" that showed a long narrow tract parallel and posterior to the esophageal column. She was mistakenly operated on with a diagnosis of esophageal duplication. Case 2 is a premature baby weighing 960g at 26 weeks gestation. She required endotracheal intubation, causing esophageal perforation into the retromediastinum. An esophagogram showed a blind pouch that ended at the level of the diaphragm. Both cases were treated successfully with conservative management. In general, esophageal perforation in neonates can be managed medically with removal of a nasogastric tube, administration of antibiotics, peripheral intravenous nutrition or feeding through a nasogastric tube when possible. Closed chest dranage may be necessary in some cases. This iatrogenic disorder should be prevented with caution.
