Noniatrogenic perfora-tions are extremely rare and these are usually seen in full term infants. The most common site is the lower end of esophagus. The usual clinical history in neonatal Boerhaave s syndrome includes dyspnea followed by cyanosis which may occur shortly after birth but is usually delayed for six to thirty hours. This is explained by the close adherance of the aorta to the left side of the esophagus in the infant which provides additional support to that side. Vomiting, coughing, choking episodes and mild hematemesis have been observed in several cases.
Subcutaneous emphysema is rare in infants unless massive pneumomediastinum occurs.
There are a number of differences between spontaneous neonatal esophageal rupture and those occurring in adults. Chest radiograph alone may be diagnostic of esophageal perforation when a hydro-pneumothorax is seen combined with air dissecting in the mediastinum. An unusual course of the nasogastric tube may be the first indication of this diagnosis. In all cases, esophagography is necessary to establish the diagnosis, localize the perforation and direct therapy. It should always be performed under fluoroscopic control.