Management of esophageal perforation in infants resulting from transesophageal echocardiogram probes

Abstract

Iatrogenic esophageal perforation in infants is an uncommon though recognized complication resulting from the insertion of a transesophageal echocardiogram (TEE) probe into the oropharynx. Infants requiring TEE are almost universally affected by underlying cardiac disease; thus, minimizing unnecessary interventions is the goal. We reviewed our institution’s experience with esophageal perforation resulting from TEE probes in order to define effective management strategies. After IRB approval, we conducted a 12-year retrospective review of our institution’s experience with esophageal perforation in infants resulting from TEE probes. During our study period, 3322 infants had a TEE probe placed. Four infants (age range 2e120 days) sustained an esophageal perforation from a TEE probe, indicating that the incidence at our institution is 0.12%. Evaluation with contrast esophagram or direct laryngoscopy confirmed the presence of perforation in all cases. Management consisted of broad-spectrum antibiotics and nothing per os. One patient developed a pseudodiverticulum, which regressed spontaneously. There were no other complications resulting from perforation. Transesophageal echocardiogram probe insertion in infants with cardiac anomalies can lead to esophageal perforation. These patients can be managed non-operatively with broad-spectrum antibiotics and nothing per os. Oral feeding may resume once the perforation is healed on esophagram.