Of all the perforations of the alimentary tract, perforations of the esophagus are considered the most dire and life-threatening. Historically, esophageal perforations in children were treated with highly invasive procedures in similar fashion to those carried out in adults. However, we have learned that esophageal perforations in children are: (i) more often iatrogenic, (ii) more likely to occur within the cervical esophagus, and (iii) not generally associated with an underlying malignant disease process. These important distinctions have allowed for successful non-surgical treatment strategies in the pediatric population. Although there remains a clear role for surgical therapy in selected children with esophageal perforations, the management paradigm has clearly shifted towards less invasive treatment modalities as the first line of therapy in children who are otherwise clinically stable.
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