{'fraction_non_alphanumeric': 0.026656213249705997, 'fraction_numerical': 0.007056056448451587, 'mean_word_length': 5.332506203473946, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
IDDF2018-ABS-0018 Boerhaave’s syndrome: a rare cause of hydro-pneumothorax in newborn

Background Hydro-pneumothorax following spontaneous esophageal rupture (Boerhaave’s Syndrome) is very rare and often fatal. Early diagnosis and treatment of esophageal perforation can be life-saving. Methods We report a case of a 4 day old term female baby weighing 2800grams. She was admitted with complaints of excessive cry, vomiting, refusal to feed and fast breathing for one day. The baby was exclusively breastfed since birth and was well until one day before admission. On examination, there was severe respiratory distress, cyanosis and pooling of oral secretions. On palpation, crepitus was appreciated on the skin overlying on the right side of the chest wall (suggestive of subcutaneous emphysema). On ausculatation, entire right side of the chest had decreased air entry which raised suspicion of pneumothorax. Chest X-ray revealed subcutaneous emphysema, right-sided pneumothorax with underlying collapse and orogastric feeding tube was located in the right thoracic cavity (figure 1). Ultrasound chest showed right-sided air with pleural collection with 2 mm septations. A tube thoracostomy was done on day 2 of admission. Later, the baby was put on a ventilator in view of type I respiratory failure. CECT thorax was done which showed right-sided hydro-pneumothorax with free air pocket in peri-esophageal region in the upper thoracic oesophagus. After giving contrast through ryles tube, free spillage of contrast was seen in right pleural cavity suggestive of rupture of oesophagus. Results Since the baby was hemodynamically stable, conservative management was done. After 10 days of conservative management, she was referred and transferred to surgical management where the primary repair was done. Follow up after surgery showed clinical improvement. Conclusions Spontaneous rupture of oesophagus (Boerhaave’s Syndrome) in neonates is rare with high mortatlity. Radiological findings include subcutaneous emphysema, hydro pneumothorax, mediastinal/sub diaphragmatic air. The diagnosis is confirmed by the extravasation of contrast material while performing contrast esophagography with or without CT chest. A conservative non-operative approach is preferred. Surgical closure is by primary repair/resection of the defect, diversion or esophagectomy. This case report aims to create awareness about the importance of early recognition of this life-threatening condition, which if treated timely can be life-saving. Figure. No caption available.