Home Past Issue About IP About IAP Feedback Links Author Info. Subscription Case Reports Indian Pediatrics 2000;37: 1134-1137 Neonatal Pharyngeal Pseudo-Diverticulum Y.K. Sarin D. Goel N.B. Mathur* A. Maria* From the Departments of Pediatric Surgery and Pediatrics*, Maulana Azad Medical College, New Delhi 110 002, India. Reprint requests: Dr. Yogesh Kumar Sarin, Associate Profesoor and Head, Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi 110 002, India. Manuscript Received: March 6, 2000; Initial review completed: March 20, 2000; Revision Accepted: April 10, 2000 Accidental perforation of the esophagus and hypopharynx occurs rarely in newborn infants(1-3). The risk of misdiagnosing these perforations as esophageal atresia is quite high as clinical presentation is similar(4,5). This is important, as the management of these perforations is largely conservative, whereas esophageal atresia will require operative correction. Early clues to the diagnosis of pharyngo-esophageal perforation may be subtle but should be looked for before instituting the specific treatment. In this report, we present an unusual case of neonatal pharyngo-esophageal perforation resulting in pharyngeal pseudo- diverticulum, which required operative intervention. Case study A full-term, 21-day-old female neonate, weighing 3 kg, was admitted to the Referral Nursery of Department of Pediatrics with complaints of excessive salivation and inability to feed for eight days. The baby had been feeding well till the 11th day of life. On repeated questioning, the mother recalled some degree of salivation since birth. The pregnancy was uncomplicated and the vaginal delivery was conducted at home by traditional untrained birth-attendant. There was no history of endotracheal or nasogastric intubations. A clinical diagnosis of pharyngeal pseudo-diverti-culum was made. With a little manoeuvring, a nasogastric tube could be passed in the stomach and the nasogastric feeds were initiated. The neonate required very frequent suctioning to clear the oropharynx of secretions. Esophagography performed after two weeks revealed pharyngeal pseudo-diverticulum; the dye passed freely into the stomach (Fig. 1). The child continued to have excessive salivation even at four weeks of expectant management. At this stage, differen-tial diagnosis of a true pharyngeal diverticu-lum was entertained. A true diverticulum is not expected to resolve with expectant therapy as against a pseudo-diverticulum, which has been known to resolve in 7 to 10 days. Esophago-scopy could not differentiate whether it was a true or a pseudo-diverticulum. A cervical exploration was then undertaken; it revealed pharyngeal pseudo- diverticulum and a 3 cm long longitudinal perforation in the region of pharyngo-esophageal junction, which was repaired in single layer using interrupted 5.0, polyglactin sutures. The infant had a stormy post- operative period including a minor salivary leak, which healed spontaneously. The oral secretions subsided slowly. A repeat esophagography performed three weeks post-operatively revealed normal esophageal anatomy. The infant was discharged after two months of hospitalization and has been doing well on follow-up. Discussion Eklof first reported perforation of the hypopharynx or cervical esophagus in a newborn caused by an aspiration catheter in 1968(6). Since then, case reports have appeared in the literature describing the etiological factors, the clinical features and the management of neonatal pharyngo-esophageal perfora- tions(3,5).