Perforation of the esophagus in children, though infrequent, usually follows the accidental swallowing of almost any sort of object. Studies of foreign bodies in the air and the food passages1 showed that most of the objects were not food particles. Although spontaneous rupture of the esophagus may occur, it is extremely rare.2
The diagnosis of perforation of the esophagus is often only inferred, even after careful endoscopic examination. Prudence demands that any mucosal injury be viewed with suspicion and that the patient be followed by frequent roentgen studies. Guthrie and Holland3 formulated some roentgen criteria for the presence of a foreign body or abrasion of the esophageal mucosa, namely, (1) "hold-up" of swallowed opaque material, usually associated with some regurgitation, and (2) division of the medium into two streams which reunite lower down. McGibbon and Mather4 noted the "hold-up" of a small piece of cotton wool
WALLFIELD MJ. PLEURAL MANIFESTATIONS OF PERFORATION OF THE ESOPHAGUS. Am J Dis Child. 1939;58(6):1261–1264. doi:10.1001/archpedi.1939.01990110125010
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