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How common is esophageal perforation?
The most common cause of esophageal perforation in the pediatric population is iatrogenic injury secondary to instrumentation. Iatrogenic injury is responsible for nearly 60% of all reported esophageal perforations in recent series. Esophageal perforation during upper endoscopy is estimated at a frequency of 0.03% for flexible and 0.11% for rigid endoscopy. Most of the perforations occur in the hypopharynx or upper esophagus . The actual incidence of esophageal perforation in the pediatric population is not known but varies in different age groups. Mortality associated with esophageal perforation approaches 30% .
Newborn infants, especially premature infants, are prone to injury from either endotracheal tube or oro/nasogastric tube insertion. This most commonly occurs just proximal to the most narrow portion of the esophagus - the cricopharyngeus muscle.
Esophageal perforation in young children is often sustained from caustic ingestion and/or foreign objects. The incidence of esophageal perforation from chemical ingestion has been reduced with improvements in child safety measures and patient education. However, objects such as toys and batteries remain a major health concern. The annual incidence of battery ingestion has been stable, fluctuating between 6.3 and 15.1 cases per one million people. However, there has been a 6.7 fold increase major or fatal outcomes due to ingestion. This increase in severity is largely attributed to the emergence of the 20 mm diameter lithium button battery .
Traumatic esophageal perforation is uncommon in children accounting for less than one percent of thoracic injuries. Most are a result of penetrating trauma.