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Cavazos Castro AJ, Harold CA, Asz Sigall J, Ortega Ramírez ME, Espinosa Guerrero CE, Carvajal HG. Neonatal total gastrectomy as treatment for gastric rupture: Case report. Int J Surg Case Rep 2025; 129:111217. [PMID: 40157066 PMCID: PMC11994338 DOI: 10.1016/j.ijscr.2025.111217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Revised: 03/19/2025] [Accepted: 03/26/2025] [Indexed: 04/01/2025] Open
Abstract
INTRODUCTION Neonatal gastric perforation is an uncommon but life-threatening condition, rarely requiring gastrectomy. We report the case of a neonate requiring total gastrectomy secondary to suspected barotrauma leading to gastric perforation. CASE PRESENTATION A 2-day-old term male was referred to our institution in extremis following attempted resuscitation with makeshift positive airway pressure ventilation in the setting of respiratory distress. Exam was notable for a distended, peritonitic abdomen, and abdominal radiograph showed massive pneumoperitoneum. Exploratory laparotomy revealed an extensive anterior gastric perforation extending from the pylorus to the esophagogastric junction, along with gross ischemia of the posterior gastric wall. The patient underwent gastrectomy with pouchless retrocolic Roux-en-Y esophagojejunostomy reconstruction. He was kept NPO (nil per os) on total parenteral nutrition for seven days. Esophagram on postoperative day 7 demonstrated patency of the esophagojejunal anastomosis without leaks, and he was transitioned to formula via nasojejunal tube feeds supplemented with vitamins and pancreatic enzymes. He was discharged home on postoperative day 45. At latest follow-up 2.9 years after surgery, his height and weight were in the 10th percentile for his age. CLINICAL DISCUSSION This report showcases the successful management of an extensive gastric perforation with gastrectomy and pouchless Roux-en-Y esophagojejunostomy. Multidisciplinary postoperative and outpatient care was essential to ensure a positive outcome. CONCLUSION Neonatal gastric perforation is a rare condition with high morbidity and mortality, particularly in those born prematurely or low birthweight. This patient suffered from an extensive gastric perforation secondary to suspected barotrauma, undergoing gastrectomy and esophagojejunostomy without a pouch, achieving adequate nutritional status for his age.
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Affiliation(s)
- Arturo Javier Cavazos Castro
- Department of Pediatric Surgery, National Institute of Pediatrics, Av. Insurgentes Sur No. 3700-C, 04530 Mexico City, Mexico.
| | - Castro Anaya Harold
- Department of Pediatric Surgery, National Institute of Pediatrics, Av. Insurgentes Sur No. 3700-C, 04530 Mexico City, Mexico
| | - José Asz Sigall
- Department of Pediatric Surgery, National Institute of Pediatrics, Av. Insurgentes Sur No. 3700-C, 04530 Mexico City, Mexico
| | - María Elena Ortega Ramírez
- Department of Neonatology, National Institute of Pediatrics, Av. Insurgentes Sur No. 3700-C, 04530 Mexico City, Mexico
| | | | - Horacio G Carvajal
- Division of Pediatric Cardiothoracic Surgery, University of Utah, United States of America.
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Mengying C, Pengfei C, Jinfeng H, Yi W, Wei L, Zhenhua G. Visualization of Risk Factors and Predictive Models for Early Death of Neonatal Gastric Perforation. Clin Pediatr (Phila) 2024; 63:986-994. [PMID: 37750300 DOI: 10.1177/00099228231201315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
A retrospective analysis was performed from May 2003 to October 2021 at our hospital. One hundred and eleven neonates diagnosed with gastric perforation were categorized into non-survivor and survivor groups based on prognosis. The mortality rate was 23.42%. Logistic regression was used to analyze the factors influencing the early neonatal death. The non-survivor groups showed more abdominal distension, vomiting, hypoxia, acidosis, hyperkalemia, and coagulation abnormalities. Serum potassium concentration (odds ratio [OR] 2.148, P = .043) was an independent risk factor; however, arterial partial pressure of oxygen (OR 0.977, P = .024), bicarbonate (OR 0.779, P = .023), and platelet count (OR 0.986, P = .014) had protective effects on neonatal death. Based on this, a visualized nomogram prediction model was constructed, patients who had a nomogram score of more than 163.787 was considered to have high risks of mortality, the area under the curve of this was up to 0.828 (95% confidence interval [0.733, 0.923]), the sensitivity was 80.0%, and the specificity was 76.9%.
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Affiliation(s)
- Cui Mengying
- Department of General Surgery & Neonatal Surgery, Liangjiang Wing, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chen Pengfei
- Department of General Surgery & Neonatal Surgery, Liangjiang Wing, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Hou Jinfeng
- Department of General Surgery & Neonatal Surgery, Liangjiang Wing, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wang Yi
- Department of General Surgery & Neonatal Surgery, Liangjiang Wing, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Liu Wei
- Department of General Surgery & Neonatal Surgery, Liangjiang Wing, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Guo Zhenhua
- Department of General Surgery & Neonatal Surgery, Liangjiang Wing, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
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Khemakhem RK, Mahdi DEA, Algethami NE, AlQurashi RH, Alnemari AK, Al Thobaiti RA. Neonatal Gastric Necrosis and Perforation Treated by Subtotal Gastrectomy and Esogastric Anastomosis: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931820. [PMID: 34962911 PMCID: PMC8721988 DOI: 10.12659/ajcr.931820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patient: Male, 4-day-old
Final Diagnosis: Gastric perforation and necrosis
Symptoms: Acute abdominal distension • metabolic acidosis • respiratory distress
Medication: —
Clinical Procedure: —
Specialty: Pediatrics and Neonatology • Surgery
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Affiliation(s)
- Rachid K Khemakhem
- Department of Pediatric Surgery, King Faisal Medical Complex, Taif, Saudi Arabia
| | - Diaa Eldin A Mahdi
- Department of Pediatric Surgery, King Faisal Medical Complex, Taif, Saudi Arabia
| | | | | | - Amal K Alnemari
- Department of Intensive Care Unit (ICU), Heraa General Hospital, Makkah, Saudi Arabia
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Watch your numbers! Avoiding gastric perforation from feeding tubes in neonates. Pediatr Neonatol 2021; 62:681-682. [PMID: 34393087 DOI: 10.1016/j.pedneo.2021.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/14/2021] [Accepted: 06/24/2021] [Indexed: 11/22/2022] Open
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Hashim I, Talat N, Iqbal A, Choudhary MS, Haider N, Nayyer SI, Sharif M, Wasti AR, Ahmad S. Spontaneous gastric perforation: is it really common? ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00083-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Neonatal gastric perforation (NGP) is a rare, serious, and life-threatening condition which needs early recognition with prompt intervention for better prognosis. Its etiology is not yet well established, but multiple speculations have been put forth for its etiopathogenesis. Few most considered are traumatic, spontaneous, or secondary to inflammatory process like necrotizing enterocolitis. This study describes the etiological and prognostic factors for patients with NGP in our experience at a single center.
Results
A total of 46 neonates were included. Male gender predominated with M:F being 1.7:1. Most (n=36) neonates presented within 10 days of life whereas 8 neonates presented within 15 days. At presentation, gas under diaphragm was the most common radiologic finding in 25 (54.3%) neonates. On exploratory laparotomy, it was found that greater curvature was involved in maximum number of cases (n=27), followed by lesser curvature and anterior and posterior walls of the stomach. Most of perforations were within 1–5 cm in size. Gastrorrhaphy was done in all cases, and in two cases, feeding jejunostomy was done along with repair for feeding purpose. Finally, spontaneous NGP was diagnosed in 30 (60.8%), and NEC patches on other parts of the intestine were seen in 11 patients. Postoperatively, 28 neonates developed complications in the form of sepsis (n=13), wound infection (n=10), and burst abdomen (n=5). Regarding clinical outcome, 27 (58.7%) were discharged from the hospital whereas 19 (39.3%) patients died.
Conclusion
Our results show that spontaneous NGP is most commonly associated with NEC in our population, usually affecting the greater curvature. We observed a high mortality rate; however, good ICU care may improve the survival.
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Huang Y, Lu Q, Peng N, Wang L, Song Y, Zhong Q, Yuan P. Risk Factors for Mortality in Neonatal Gastric Perforation: A Retrospective Cohort Study. Front Pediatr 2021; 9:652139. [PMID: 34055689 PMCID: PMC8155276 DOI: 10.3389/fped.2021.652139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/19/2021] [Indexed: 01/14/2023] Open
Abstract
Background: Neonatal gastric perforation is a rare but life-threatening issue. The aim of this study was to describe the clinical characteristics and prognosis of patients with neonatal gastric perforation and identify predictive factors for poor prognosis. Methods: This was a retrospective cohort study of patients with neonatal gastric perforation treated in a tertiary pediatric public hospital between April 2009 and October 2020. The enrolled patients were divided into survival and non-survival groups. Demographic information, clinical characteristics, laboratory and imaging features, and outcomes were collected from the electronic medical record. Univariate and multivariate logistic regression analyses were performed to obtain the independent factors associated with death risk. Additionally, we separated this population into two groups (pre-term and term groups) and explored the mortality predictors of these two groups, respectively. Results: A total of 101 patients with neonatal gastric perforation were included in this study. The overall survival rate was 70.3%. Seventy-one (70.3%) were pre-term neonates, and sixty-two (61.4%) were low-birth-weight neonates. The median age of onset was 3 days (range: 1-11 days). Abdominal distension [98 (97.0%) patients] was the most common symptom, followed by lethargy [78 (77.2%) patients], shortness of breath [60 (59.4%) patients] and vomiting [34 (33.7%) patients]. Three independent mortality risk factors were identified: shock (OR, 3.749; 95% CI, 1.247-11.269; p = 0.019), serum lactic acid > 2.5 mmol/L (5.346; 1.727-16.547; p = 0.004) and platelet count <150 × 109/L (3.510; 1.115-11.053; p = 0.032). There was a borderline significant association between sclerema neonatorum and total mortality (4.827; 0.889-26.220; p = 0.068). In pre-term infants, serum lactic acid > 2.5 mmol/L and platelet count <150 × 109/L remained independent risk factors for death. In term infants, the incidence of shock, coagulopathy, pH < 7.3, serum lactic acid > 2.5 mmol/L, and hyponatremia were statistically different between non-survival and survival groups. Conclusion: Shock, hyperlactatemia, and thrombocytopenia are independently associated with an increased risk of death in patients with neonatal gastric perforation. Identification of modifiable risk factors during the critical periods of life will contribute to the development of effective prevention and intervention strategies of neonatal gastric perforation.
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Affiliation(s)
- Yao Huang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qi Lu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Nan Peng
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Li Wang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yan Song
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qin Zhong
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Peng Yuan
- Department of Neonatal Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
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Theodorou CM, Chen P, Vanover MA, Saadai P, Brown EG, Haas KB, Hirose S. Total gastrectomy with delayed Hunt-Lawrence pouch reconstruction for neonatal gastric perforation presenting with hematemesis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020; 63:101686. [PMID: 33184604 PMCID: PMC7654623 DOI: 10.1016/j.epsc.2020.101686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The differential for neonatal hematoma sis ranges from benign etiologies to life-threatening emergencies. Neonatal gastric perforation is a rare cause of neonatal hematoma sis but is a deadly condition, requiring prompt diagnosis and treatment. The etiology is usually related to conditions predisposing to over distension of the stomach, such as positive pressure ventilation or distal obstruction, but in some cases cannot be determined. Patients generally present with abdominal distension and respiratory distress. We present a case of a 1-day old term baby girl who developed sudden onset hematoma sis and clinical deterioration, who was found to have a large proximal gastric perforation requiring emergent total gastrectomy with delayed reconstruction.
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Affiliation(s)
- Christina M. Theodorou
- University of California, Davis Medical Center. Department
of Surgery, Division of Pediatric General, Thoracic and Fetal Surgery, United
States
| | - Peggy Chen
- University of California, Davis Medical Center. Department
of Pediatrics, Division of Neonatology, United States
| | - Melissa A. Vanover
- University of California, Davis Medical Center. Department
of Surgery, Division of Pediatric General, Thoracic and Fetal Surgery, United
States
| | - Payam Saadai
- University of California, Davis Medical Center. Department
of Surgery, Division of Pediatric General, Thoracic and Fetal Surgery, United
States
| | - Erin G. Brown
- University of California, Davis Medical Center. Department
of Surgery, Division of Pediatric General, Thoracic and Fetal Surgery, United
States
| | - Kelly B. Haas
- University of California, Davis Medical Center. Department
of Pediatrics, Division of Pediatric Gastroenterology, United States
| | - Shinjiro Hirose
- University of California, Davis Medical Center. Department
of Surgery, Division of Pediatric General, Thoracic and Fetal Surgery, United
States
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Okumuş M, Zübarioğlu AU, Atalan R. Treatment of two newborns with esophageal atresia and distal tracheoesophageal fistula complicated by gastric perforation: choosing the simple way. Acta Chir Belg 2020; 120:282-285. [PMID: 30714508 DOI: 10.1080/00015458.2018.1564491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Gastric distention and perforation are possible results in a preterm newborn with esophageal atresia and distal tracheoesophageal fistula, especially when there is a need for mechanical ventilatory support. The results of the reported cases treated with emergency thoracotomy and fistula ligation after gastrostomy are not very satisfactory. Sometimes simple temporary solutions can be useful for stabilization and allow safety for required surgical treatment for later.Patient and methods: Two preterm newborns with esophageal atresia and distal tracheoesophageal fistula complicated by gastric perforation were reported.Results: Both of the patients were initially treated with a simple peritoneal drainage and, then the definitive operations were performed without any problem in stabilized patients.Conclusion: Performing fistula ligation or occlusion as an initial treatment in patients with impaired cardiac and respiratory functions may worsen the status of the patient. In such cases, it could be better to perform simple interventions first to facilitate subsequent treatments.
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Affiliation(s)
- Mustafa Okumuş
- Department of Pediatric Surgery, Yeni Yüzyıl University, Faculty of Medicine Gaziosmanpaşa and Bahat Hospital, Gaziomanpaşa, Turkey
| | - Adil Umut Zübarioğlu
- Department of Pediatrics Division of Neonatology, Yeni Yüzyıl University, Faculty of Medicine, Gaziosmanpaşa Hospital, Gaziosmanpaşa, Turkey
| | - Reşit Atalan
- Department of Pediatrics, Bahat Hospital, Sultangazi, Turkey
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Garge SS, Paliwal G. Neonatal Gastric Perforation: Our Experience and Important Preoperative and Intraoperative Caveats to Prognosticate and Improve Survival. J Indian Assoc Pediatr Surg 2020; 25:201-205. [PMID: 32939110 PMCID: PMC7478279 DOI: 10.4103/jiaps.jiaps_80_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 06/28/2019] [Accepted: 09/14/2019] [Indexed: 12/04/2022] Open
Abstract
Aim: Neonatal gastric perforation (NGP) is a rare, perplexing, life-threatening entity affecting neonates. We share our experience of operating upon cases of NGP s and highlight important points observed which may aid in further improving care of neonates, diagnosed with this entity. Materials and Methods: A retrospective analysis of all consecutive patients with NGP operated by the author, at various centers between January 2015 and December 2018, was carried out. We analyzed different variables for these and reached logical conclusions. Results: Between January 2015 and December 2018, we treated ten patients with gastric perforation. All the neonates were preterm, except one. Mean birth weight in our series was 1745 g (range 1300–2400 g). Deterioration in activity, worsening of sepsis, metabolic acidosis, increased ventilator requirements, and abdominal distension were prominent clinical features identified in all patients. All patients subsequently had massive pneumoperitoneum before surgery. Six patients had perforation along the greater curvature, two had perforation at the posterior wall, and two had near total gastric necrosis. We had four mortalities out of ten patients operated. Conclusion: NGP is associated with high mortality, especially in premature and low birth weight neonates. Severity of contributing factors in a premature predisposed neonate determines the severity of gastric necrosis, which in turn is an important prognostic factor. Certain preoperative signs can be useful and can aid in initiating preventive measures to curtail severity of the pathology.
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Affiliation(s)
- Saurabh Shyam Garge
- Department of Surgery, Amaltas Institute of Medical Sciences, Dewas, Madhya Pradesh, India
| | - Geetika Paliwal
- Department of Surgery, Amaltas Institute of Medical Sciences, Dewas, Madhya Pradesh, India
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Sloane AJ, Phillips MR, Gupta AO, Berman L. Successful Use of a Damage Control Surgery for a Premature Infant with Massive Gastric Necrosis and Perforation. Am Surg 2020. [DOI: 10.1177/000313482008600104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Amy J. Sloane
- Nemours/Alfred I. duPont Hospital for Children Wilmington, Delaware
| | | | - Ashish O. Gupta
- Nemours/Alfred I. duPont Hospital for Children Wilmington, Delaware
| | - Loren Berman
- Nemours/Alfred I. duPont Hospital for Children Wilmington, Delaware
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Pediatric gastric perforation beyond neonatal period: 8-year experience with 20 patients. Pediatr Neonatol 2019; 60:634-640. [PMID: 30992193 DOI: 10.1016/j.pedneo.2019.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To describe the characteristics, treatments, and prognosis of pediatric gastric perforation patients beyond neonatal period. METHODS Twenty pediatric patients beyond neonatal period were included in this study. Medical records were reviewed and clinical characteristics were analyzed. According to the outcomes, patients were divided into the survival group and the death group. Death time was documented, and survival patients were followed up. The degree of severity was calculated using pediatric critical illness score (PCIS). Differences between the two groups were analyzed by the Student's t-test, Mann-Whitney test and Chi-square test appropriately. RESULTS Gastric perforation was diagnosed in 20 pediatric patients beyond neonatal period, including 6 males (30%) and 14 females (70%), with the age of 37.18 (15.90, 107.12) months, and the range was from 4.30 months to 14.17 years old. They had different manifestations, etiologies, sites of perforation and surgery procedures. Among the 20 cases, 14 (70%) survived and 6 (30%) died. Age, gender, length and number of perforation had no statistically difference between the two groups. However, PCIS, ischemia of gastrointestinal wall, and transmural necrosis of gastric wall were statistically different. For the survival group, during a follow-up period of 50 (36, 68) months, ranging from 2 months to 8 years and 7 months, one patient had a second-time perforation, another 3 patients had brain injury symptoms, and the rest 10 patients had good quality of lives. CONCLUSIONS Gastric perforation of pediatric patients beyond neonatal period causes a mortality of 30% on this study. Spontaneous great curvature of gastric wall perforation has the highest morbidity. Low PCIS predicts for unfavorable prognosis. Most of the survival patients have satisfactory living quality after operation.
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Sadat AS, Thotan SP, Prabhu SP, Kumar V, Ranjini R. Large Sealed Neonatal Gastric Perforation: A Case Report. Clin Pediatr (Phila) 2019; 58:1321-1323. [PMID: 31452401 DOI: 10.1177/0009922819870556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - Vijay Kumar
- Manipal Academy of Higher Education, Manipal, India
| | - R Ranjini
- Manipal Academy of Higher Education, Manipal, India
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13
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Thaiwatcharamas K, Phannua R, Chusilp S, Tanming P, Areemit S. Neonatal gastric necrosis and perforation associated with impacted medication. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2018.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Yang T, Huang Y, Li J, Zhong W, Tan T, Yu J, Li L, Pan J, Hu C, Yang J, Zou Y. Neonatal Gastric Perforation: Case Series and Literature Review. World J Surg 2018; 42:2668-2673. [PMID: 29392435 DOI: 10.1007/s00268-018-4509-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE We reported clinical findings of neonatal gastric perforation in a tertiary children's hospital. PATIENTS AND METHODS Retrospective chart reviews were conducted for neonatal gastric perforation between 1980 and 2016. Factors including sex, gestational age, birth weight, age, main symptoms and signs, white blood cell count (WBC), surgical intervention time (time between development of main symptom and surgical intervention), surgical findings, pathologic results, clinical outcomes, and causes of death were collected. RESULTS Sixty-eight patients were identified. In total, 76.5% were male infants, the median age was 4 days, median birth weight was 2500 g, and 42.6% were premature. Abdominal distention and vomiting were the most common symptoms, and pneumoperitoneum was the most common radiographic finding. The median surgical intervention time was 51 h (range 8-312). In total, 73.5% of perforations occurred in the great curvature, 17.6% in the lesser curvature, and 8.9% unspecified. The median perforation size was 4 cm (range 0.2-16). Associated gastrointestinal anomalies were found in 20.6% of patients, and the most common anomaly was intestinal malrotation. Of the 51 patients with pathologic results, 11 showed the presence of musculature in the perforated gastric wall, while 40 showed the absence of musculature. Of the 66 patients with known clinical outcomes, 26 (39.4%) died, 23 of who died of infection. Among those aforementioned factors, WBC has a significant impact on survival. The mortality for four arbitrary divided year groups (1980-1989, 1990-1999, 2000-2009, and 2010-2016) was 100, 50, 31.6, and 16.7%, respectively. CONCLUSIONS The mortality of neonatal gastric perforation is constantly decreasing. Associated gastrointestinal anomalies and the presence of musculature are found in a minority of this condition.
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Affiliation(s)
- Tianyou Yang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Rd., Tianhe District, Guangzhou, 510623, China
| | - Yongbo Huang
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiahao Li
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Rd., Tianhe District, Guangzhou, 510623, China
| | - Wei Zhong
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Rd., Tianhe District, Guangzhou, 510623, China
| | - Tianbao Tan
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Rd., Tianhe District, Guangzhou, 510623, China
| | - Jiakang Yu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Rd., Tianhe District, Guangzhou, 510623, China
| | - Le Li
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Rd., Tianhe District, Guangzhou, 510623, China
| | - Jing Pan
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Rd., Tianhe District, Guangzhou, 510623, China
| | - Chao Hu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Rd., Tianhe District, Guangzhou, 510623, China
| | - Jiliang Yang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Rd., Tianhe District, Guangzhou, 510623, China
| | - Yan Zou
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Rd., Tianhe District, Guangzhou, 510623, China.
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15
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Choi YJ, Cho YH, Kim SH, Kim HY. Clinical implication of spontaneous gastrointestinal perforation in pediatric patients: its difference according to age group. Ann Surg Treat Res 2018; 95:141-146. [PMID: 30182020 PMCID: PMC6121166 DOI: 10.4174/astr.2018.95.3.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/28/2017] [Accepted: 09/05/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose Spontaneous gastrointestinal perforations (SGIPs; not associated with injury or disease) occur rarely in pediatric patients. This study aimed to define age-specific features associated with SGIPs in pediatric patients. Methods Retrospectively reviewed the clinical data of children (before adolescence) who received surgery due to a SGIP at a single institution. Thirty-nine patients were enrolled. Characteristics were compared between the 2 age groups: neonates (group A) and beyond neonates (group B). Results Group A included 24 patients (61.5%) an group B included 15 patients (38.5%). Thirteen perforations occurred in the stomach (33.3%), 12 in the small intestine (30.8%), and 14 in the large intestine (35.9%). A significantly higher proportion of perforations occurred in the stomach and small intestine in group A, while more perforations occurred in the large intestine in group B (P = 0.01). Several associated conditions during the preoperative period were identified in both groups. The overall mortality rate was 15.4% (6 of 39). Mortality was relatively high in group A (5 of 24, 20.8%) and for perforations of stomach (3 of 13, 23.1%) and small intestine (3 of 12, 25.0%); however, there were no significant differences with regard to age or perforation site (P = 0.244, P = 0.122, respectively). Conclusion SGIPs in pediatric patients had diverse clinical features and different perforation patterns according to age group. However, no significant group differences in mortality were found. Thus, favorable results regardless of age can be expected with prompt recognition, medical resuscitation, and adequate surgical management.
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Affiliation(s)
- Young-Jin Choi
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yong-Hoon Cho
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Soo-Hong Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hae-Young Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
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16
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Cardiel-Marmolejo L, Peña A, Urrutia-Moya L, Crespo-Smith D, Morales-Vivas C, Camacho-Juárez K, Roque-Ibáñez C. Neonatal gastric perforation: A case report. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2018. [DOI: 10.1016/j.hgmx.2016.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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17
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Chen TY, Liu HK, Yang MC, Yang YN, Ko PJ, Su YT, Huang RY, Tsai CC. Neonatal gastric perforation: a report of two cases and a systematic review. Medicine (Baltimore) 2018; 97:e0369. [PMID: 29702982 PMCID: PMC5944554 DOI: 10.1097/md.0000000000010369] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/01/2018] [Accepted: 03/16/2018] [Indexed: 01/14/2023] Open
Abstract
RATIONALE Neonatal gastric perforation is a rare and life-threatening disorder in neonates and is associated with high morbidity and mortality. However, the exact mechanisms of neonatal gastric perforation remain unknown. PATIENT CONCERNS In this study, we reported 2 cases of neonatal gastric perforation and conducted a systematic review to analyze the prognostic factors for mortality. DIAGNOSES Two neonates received a diagnosis of gastric perforation based on clinical presentation and imaging studies. The 2 patients underwent emergent surgery, which yielded favorable outcomes. INTERVENTIONS We reviewed 168 cases from the literature as well as our 2 cases to analyze whether mortality in neonatal gastric perforation is associated with sex, gestational age, operation type, perforation location, or timing of perforation. OUTCOMES The results revealed that mortality was significantly higher in preterm neonates (n = 80, P < .01) and the mortality group had a lower birth weight (n = 73, P < .05). The timing of perforation in the preterm subgroup was significantly earlier than that in the full-term subgroup (n = 90, P < .05). The outcomes about mortality of gastric perforation were significantly associated with preterm neonates (adjusted odds ratio: 4.21, 95% confidence interval: 1.28-13.88, P < .05). LESSONS This study shows the prognostic factor of gastric perforation was significantly associated with preterm neonates. Furthermore, low-birth-weight full-term neonates had a relatively higher mortality rate than the normal-birth-weight full-term neonates. In addition, preterm neonates have an earlier timing of perforation.
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Affiliation(s)
| | | | - Ming-Chun Yang
- Department of Pediatrics, E-Da Hospital
- School of Chinese Medicine for Post Baccalaureate, I-Shou University
| | | | | | | | - Ru-Yi Huang
- Department of Medical Education, E-Da Hospital, I-Shou University, Yanchao District, Kaohsiung City, Taiwan, R.O.C
| | - Ching-Chung Tsai
- Department of Pediatrics, E-Da Hospital
- School of Chinese Medicine for Post Baccalaureate, I-Shou University
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18
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Babayigit A, Ozaydın S, Cetinkaya M, Sander S. Neonatal gastric perforations in very low birth weight infants: a single center experience and review of the literature. Pediatr Surg Int 2018; 34:79-84. [PMID: 29079904 DOI: 10.1007/s00383-017-4205-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Gastric perforation is a rare condition with high mortality rates in preterm infants. The aim of this retrospective study was to define the risk factors and prognosis in very low birth weight (VLBW) infants with gastric perforations. METHODS VLBW infants with a diagnosis of gastric perforation between 2012 and 2016 were included. The data including birth weight, gestational age, gender, risk factors, time and location of the perforation and prognosis were recorded. RESULTS A total of eight infants were identified. The median gestational age and birth weight of the infants were 26 weeks and 860 g, respectively. Five were male and 6 (75%) had a diagnosis of hemodynamically significant patent ductus arteriosus (PDA), early sepsis, persistent hypotension, and drug administration (paracetamol, ibuprofen). The main clinical finding was abdominal distension and pneumoperitoneum was detected in all infants. The median diagnosis was 6 days of life. The median perforation size was 2.5 cm and curvature major and anterior wall were the most common locations. The mortality rate was 62.5%. CONCLUSION Male gender, chorioamnionitis, early sepsis, asphyxia, hemodynamic PDA, persistent hypotension, ibuprofen and paracetamol usage, and orogastric catheter administration were the main risk factors for gastric perforations in VLBW infants.
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Affiliation(s)
- Aslan Babayigit
- Department of Neonatology, Kanuni Sultan Suleyman Training and Research Hospital, Turgut Ozal Caddesi No:1 34303 Altınsehir, Kucukcekmece, Istanbul, Turkey
| | - Seyithan Ozaydın
- Department of Neonatology, Kanuni Sultan Suleyman Training and Research Hospital, Turgut Ozal Caddesi No:1 34303 Altınsehir, Kucukcekmece, Istanbul, Turkey.,Department of Pediatric Surgery, Kanuni Sultan Suleyman Training and Research Hospital, Turgut Ozal Caddesi No:1 34303 Altınsehir, Kucukcekmece, Istanbul, Turkey
| | - Merih Cetinkaya
- Department of Neonatology, Kanuni Sultan Suleyman Training and Research Hospital, Turgut Ozal Caddesi No:1 34303 Altınsehir, Kucukcekmece, Istanbul, Turkey.
| | - Serdar Sander
- Department of Neonatology, Kanuni Sultan Suleyman Training and Research Hospital, Turgut Ozal Caddesi No:1 34303 Altınsehir, Kucukcekmece, Istanbul, Turkey.,Department of Pediatric Surgery, Kanuni Sultan Suleyman Training and Research Hospital, Turgut Ozal Caddesi No:1 34303 Altınsehir, Kucukcekmece, Istanbul, Turkey
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19
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Reyna-Sepulveda F. Neonatal Sleeve Gastrectomy for Multiple Gastric Perforations: A Case Report. J Neonatal Surg 2017; 6:10. [PMID: 28083496 PMCID: PMC5224743 DOI: 10.21699/jns.v5i3.355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/20/2016] [Indexed: 11/11/2022] Open
Abstract
Neonatal gastric perforation (NGP) may be spontaneous, secondary to necrotizing enterocolitis (NEC), or due to distal obstruction. A 27-week old premature male newborn presented with pneumoperitoneum. A single perforation of stomach was found at surgery. Primary repair and gastrostomy were performed. On fifth postoperative day, pneumoperitoneum was again detected. At reoperation, multiple gastric perforations of the greater curvature were found. Sleeve gastrectomy was performed. The patient responded well to the treatment.
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Affiliation(s)
- Francisco Reyna-Sepulveda
- General Surgery Department, University Hospital "Dr. José Eleuterio González", Autonomous University of Nuevo León
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20
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Antabak A, Bogović M, Vuković J, Grizelj R, Babić VB, Papeš D, Luetić T. Postoperative Gastric Perforation in a Newborn with Duodenal Atresia. J Neonatal Surg 2016; 5:62. [PMID: 27896170 PMCID: PMC5117285 DOI: 10.21699/jns.v5i4.469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 09/03/2016] [Indexed: 11/11/2022] Open
Abstract
Gastric perforation (GP) in neonates is a rare entity with high mortality. Although the etiology is not completely understood, it mostly occurs in premature neonates on assisted ventilation. Combination of duodenal atresia and gastric perforation is very rare. We present a case duodenal atresia who developed gastric perforation after operetion for duodenal atresia. Analysis of the patient medical record and histology report did not reveal the etiology of the perforation.
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Affiliation(s)
- Anko Antabak
- Department of Surgery, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Marko Bogović
- Department of Surgery, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Jurica Vuković
- Department of Pediatrics, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Ruža Grizelj
- Department of Pediatrics, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | | | - Dino Papeš
- Department of Surgery, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Tomislav Luetić
- Department of Surgery, Clinical Hospital Center Zagreb, Zagreb, Croatia
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21
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Lee DK, Shim SY, Cho SJ, Park EA, Lee SW. Comparison of gastric and other bowel perforations in preterm infants: a review of 20 years' experience in a single institution. KOREAN JOURNAL OF PEDIATRICS 2015; 58:288-93. [PMID: 26388893 PMCID: PMC4573442 DOI: 10.3345/kjp.2015.58.8.288] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/28/2014] [Accepted: 10/20/2014] [Indexed: 01/15/2023]
Abstract
Purpose In this study, we aimed to review the clinical presentation of preterm infants with gastrointestinal perforations and compare the clinical features of gastric perforation with other intestinal perforations. Methods The medical records of preterm neonates with pneumoperitoneum, admitted to the neonatal intensive care unit (NICU) between January 1994 and December 2013, were retrospectively reviewed. Results Twenty-one preterm infants underwent exploratory laparotomy to investigate the cause of the pneumoperitoneum. The sample consisted of five patients (23.8%) with gastric perforation and 16 patients (76.2%) with intestinal perforation. No statistical differences were found in the birth history and other perinatal factors between the two groups. Underlying necrotizing enterocolitis, bilious vomiting, and paralytic ileus preceding the perforation were statistically more common in the intestinal perforation group. All preterm infants with gastric perforation survived to discharge; however, six preterm infants with intestinal perforation expired during treatment in the NICU. In the gastric perforation group, sudden pneumoperitoneum was the most common finding, and the mean age at diagnosis was 4.4±1.7 days of life. The location and size of the perforations varied, and simple closure or partial gastrectomy was performed. Conclusion Patients with gastric perforation did not have a common clinical finding preceding the perforation diagnosis. Although mortality in previous studies was high, all patients survived to discharge in the present study. When a preterm infant aged less than one week presents with sudden abdominal distension and pneumoperitoneum, gastric perforation should first be excluded. Prompt exploratory laparotomy will increase the survival rates of these infants.
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Affiliation(s)
- Do Kyung Lee
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - So Yeon Shim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Su Jin Cho
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Eun Ae Park
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sun Wha Lee
- Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea
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22
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Yang CY, Lien R, Fu RH, Chu SM, Hsu JF, Lai JY, Minoo P, Chiang MC. Prognostic factors and concomitant anomalies in neonatal gastric perforation. J Pediatr Surg 2015; 50:1278-82. [PMID: 25957026 DOI: 10.1016/j.jpedsurg.2015.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 03/24/2015] [Accepted: 04/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Neonatal gastric perforation is a rare and serious issue. This study aimed to highlight the vital clinical features and identify prognostic factors in such cases. DESIGN, SETTING, PATIENTS, INTERVENTIONS, AND MEASUREMENTS Medical charts from January 1997 through December 2008 were reviewed retrospectively. Neonates with a diagnosis of gastric perforation were included. RESULTS Thirteen patients were identified with a male:female ratio of 9:4. Five (38%) were preterm infants. The mortality rate was 30% (4/13), and the median age of onset was 3 days (range: 1-14 days). The most common presenting sign was abdominal distension, followed by respiratory distress and vomiting. Except for one patient in whom gastric perforation was diagnosed during surgical repair for gastroschisis, all patients had pneumoperitoneum on admission; 70% and 46% of patients had peritonitis and sepsis, respectively. Concomitant gastrointestinal (GI) tract anomalies or disorders included ischemic bowel/necrotizing enterocolitis (5 patients), intestinal malrotation (2), duodenal web (1), hiatal hernia (1), and gastroschisis (1), which necessitated secondary operations during hospitalization in 5 patients. Seven patients had leukopenia on admission, and 9 developed thrombocytopenia in the following 48 h. All patients who died presented with leukopenia on admission and thrombocytopenia in the following 48 h, yielding sensitivity and specificity rates of 100% and 67%, respectively. CONCLUSIONS Neonatal gastric perforation is often concomitant with GI anomalies or inflammatory/infectious disease. Patients who were outborn and those with leucopenia, peritonitis, and thrombocytopenia development within 48 h were at risk for poor outcome.
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Affiliation(s)
- Chang-Yo Yang
- Division of Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, 33305 Taiwan; USC Division of Neonatal Medicine, Department of Pediatrics, Center for Fetal and Neonatal Medicine, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA; Department of Pediatrics, The LAC/USC Medical Center, Keck School of Medicine, University of Southern California, 2051 Marengo Street, Los Angeles, CA 90033, USA; Department of Pediatrics, Division of Neonatology, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA
| | - Reyin Lien
- Division of Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, 33305 Taiwan
| | - Ren-Huei Fu
- Division of Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, 33305 Taiwan
| | - Shih-Ming Chu
- Division of Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, 33305 Taiwan
| | - Jen-Fu Hsu
- Division of Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, 33305 Taiwan
| | - Jin-Yao Lai
- Division of Pediatric Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, 33305 Taiwan
| | - Parviz Minoo
- Department of Pediatrics, Division of Neonatology, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA
| | - Ming-Chou Chiang
- Division of Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, 33305 Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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23
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Cho YH, Kim HY, Kim SH, Byun SY, Park KH, Han YM. Gastric Perforation in the Neonatal Period: Differences between Preterm and Term Infants. NEONATAL MEDICINE 2015. [DOI: 10.5385/nm.2015.22.3.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Yong Hoon Cho
- Division of Pediatric Surgery, Department of Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Hae Young Kim
- Division of Pediatric Surgery, Department of Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Soo Hong Kim
- Division of Pediatric Surgery, Department of Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Shin Yun Byun
- Division of Neonatology, Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Kyung Hee Park
- Division of Neonatology, Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Young Mi Han
- Division of Neonatology, Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
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24
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Byun J, Kim HY, Noh SY, Kim SH, Jung SE, Lee SC, Park KW. Neonatal gastric perforation: A single center experience. World J Gastrointest Surg 2014; 6:151-155. [PMID: 25161763 PMCID: PMC4143970 DOI: 10.4240/wjgs.v6.i8.151] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/23/2014] [Accepted: 07/14/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the etiology and prognostic factors for neonatal gastric perforation (NGP), a rare but life-threatening disease.
METHODS: Between 1980 and 2011, nine patients underwent surgical intervention for NGP at Seoul National University Children’s Hospital. The characteristics and prognosis of the patients were retrospectively analyzed.
RESULTS: Among the nine patients, three (33.3%) were preterm babies and five (55.5%) had associated anomalies, which included diaphragmatic eventration (n = 2), congenital diaphragmatic hernia, esophageal atresia with tracheoesophageal fistula, and antral web. Three (33.3%) patients were born before 1990 and three (33.3%) had a birth weight < 2500 g. Pneumoperitoneum was found on preoperative images in six (66.7%) patients, and incidentally in the other three (33.3%) patients. Surgery was performed within 24 h after the onset of symptoms in seven (77.8%) patients. The overall mortality rate was 22.2% (2/9). The time between symptoms and surgical intervention was the only prognostic factor for survival, whereas premature birth and birth weight were not.
CONCLUSION: Early detection and advances in neonatal intensive care may improve the prognosis of NGP.
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25
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Uettwiller F, Roullet-Renoleau N, Letouze A, Lardy H, Saliba E, Labarthe F. Gastric perforation in neonate: A rare complication of birth trauma. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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26
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Jactel SN, Abramowsky CR, Schniederjan M, Durham MM, Ricketts RR, Clifton MS, Langberg KM, Elawabdeh N, Pandya S, Talebagha S, Shehata BM. Noniatrogenic neonatal gastric perforation: the role of interstitial cells of Cajal. Fetal Pediatr Pathol 2013; 32:422-8. [PMID: 23742621 DOI: 10.3109/15513815.2013.799248] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Noniatrogenic neonatal gastric perforation is a rare and life-threatening condition whose etiology is often unclear. Interstitial cells of Cajal act as gastrointestinal pacemaker cells and express the proto-oncogene c-Kit. Six new cases were identified at our institution which presented with no mechanical, pharmacologic, or otherwise medical-related intervention prior to rupture. The number of interstitial cells of Cajal in nonnecrotic muscularis propria from five random high-power fields per specimen was compared using immunohistochemical stains for c-Kit. The authors show that a lack of interstitial cells of Cajal in the stomach musculature may be implicated in the development of noniatrogenic gastric perforation (p = 0.008). Further large-scale studies, including molecular and genetic analysis, may help to better understand this phenomenon.
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Affiliation(s)
- Samuel Noah Jactel
- 1Pathology, Childrens Hospital of Atlanta -Egleston, Emory University School of Medicine, Atlanta, Georgia, USA
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27
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Gupta G, Kumar S, Gupta S, Golhar KB, Deshpande S. Neonatal gastric perforations: are they really spontaneous? Indian J Surg 2013; 76:319-20. [PMID: 25278658 DOI: 10.1007/s12262-013-0980-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 09/16/2013] [Indexed: 11/28/2022] Open
Abstract
CASE REPORT We report a case of 4-day-old male infant who developed rapid abdominal distension with progression to shock. Abdominal radiography showed free gas under diaphragm for which emergency laparotomy was done revealing a perforation in the greater curvature of the stomach that was sutured after excising surrounding ischemic stomach wall.
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Affiliation(s)
- Gaurav Gupta
- Department of Surgery, Maharishi Markandeshwar Institute of Medical Sciences & Research, Mullana, Ambala, Haryana India
| | - Sachin Kumar
- Department of Surgery, Maharishi Markandeshwar Institute of Medical Sciences & Research, Mullana, Ambala, Haryana India
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28
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Lawther S, Patel R, Lall A. Neonatal gastric perforation with tension pneumo-peritoneum. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013; 1:14-16. [DOI: 10.1016/j.epsc.2013.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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29
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Mathew A, Wanshnong L, Longtrai S, Ghosh D. Bananas and neonatal gastric perforation. J Indian Assoc Pediatr Surg 2012; 17:88-9. [PMID: 22529561 PMCID: PMC3326835 DOI: 10.4103/0971-9261.93979] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Arpit Mathew
- Department of Surgery, Roberts Hospital, Shillong, Meghalaya, India
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It takes a mouth to eat and a nose to breathe: abnormal oral respiration affects neonates' oral competence and systemic adaptation. Int J Pediatr 2012; 2012:207605. [PMID: 22811731 PMCID: PMC3397177 DOI: 10.1155/2012/207605] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 05/10/2012] [Indexed: 12/20/2022] Open
Abstract
Mammalian, including human, neonates are considered to be obligate nose breathers. When constrained to breathe through their mouth in response to obstructed or closed nasal passages, the effects are pervasive and profound, and sometimes last into adulthood. The present paper briefly surveys neonates' and infants' responses to this atypical mobilisation of the mouth for breathing and focuses on comparisons between human newborns and infants and the neonatal rat model. We present the effects of forced oral breathing on neonatal rats induced by experimental nasal obstruction. We assessed the multilevel consequences on physiological, structural, and behavioural variables, both during and after the obstruction episode. The effects of the compensatory mobilisation of oral resources for breathing are discussed in the light of the adaptive development of oromotor functions.
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31
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Hadj-Ahmed MA, Samson N, Bussières M, Beck J, Praud JP. Absence of inspiratory laryngeal constrictor muscle activity during nasal neurally adjusted ventilatory assist in newborn lambs. J Appl Physiol (1985) 2012; 113:63-70. [PMID: 22518828 DOI: 10.1152/japplphysiol.01496.2011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
In nonsedated newborn lambs, nasal pressure support ventilation (nPSV) can lead to an active glottal closure in early inspiration, which can limit lung ventilation and divert air into the digestive system, with potentially deleterious consequences. During volume control ventilation (nVC), glottal closure is delayed to the end of inspiration, suggesting that it is reflexly linked to the maximum value of inspiratory pressure. Accordingly, the aim of the present study was to test whether inspiratory glottal closure develops at the end of inspiration during nasal neurally adjusted ventilatory assist (nNAVA), an increasingly used ventilatory mode where maximal pressure is also reached at the end of inspiration. Polysomnographic recordings were performed in eight nonsedated, chronically instrumented lambs, which were ventilated with progressively increasing levels of nPSV and nNAVA in random order. States of alertness, diaphragm, and glottal muscle electrical activity, tracheal pressure, Spo(2), tracheal Pet(CO(2)), and respiratory inductive plethysmography were continuously recorded. Although phasic inspiratory glottal constrictor electrical activity appeared during nPSV in 5 of 8 lambs, it was never observed at any nNAVA level in any lamb, even at maximal achievable nNAVA levels. In addition, a decrease in Pco(2) was neither necessary nor sufficient for the development of inspiratory glottal constrictor activity. In conclusion, nNAVA does not induce active inspiratory glottal closure, in contrast to nPSV and nVC. We hypothesize that this absence of inspiratory activity is related to the more physiological airway pressurization during nNAVA, which tightly follows diaphragm electrical activity throughout inspiration.
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Affiliation(s)
- Mohamed Amine Hadj-Ahmed
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Physiology, Université de Sherbrooke, Quebec, Canada
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Terui K, Iwai J, Yamada SI, Takenouchi A, Nakata M, Komatsu S, Yoshida H. Etiology of neonatal gastric perforation: a review of 20 years' experience. Pediatr Surg Int 2012; 28:9-14. [PMID: 22009207 DOI: 10.1007/s00383-011-3003-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Gastric perforation (GP) of the newborn is a rare, serious, and life-threatening problem, and its etiology remains unclear. Although historically GP has often been described as "spontaneous'', some cases are non-spontaneous. The aim of the present study was to review cases of GP and to discuss its etiology in a single prefecture in Japan over a period of 20 years. METHODS Eleven cases with GP that underwent surgery in 4 institutions in the Chiba Prefecture from 1991 to 2010 were reviewed and divided into 2 groups: the early (1991-2000, n = 7) and late (2001-2010, n = 4) groups. RESULTS No factors were observed that could have caused GP other than malformations associated with distal obstruction (3 midgut volvulus, 1 jejunal stenosis, 1 diaphragm eventration). Distal obstruction was present in 1 case in the early group and all 4 cases in the late group (p = 0.015). While the incidence of GP did not change over the 20-year period reviewed, the incidence of GP without distal obstruction significantly decreased in the late group. CONCLUSION The proportion of patients with GP and distal obstruction increased and true "spontaneous" cases of GP decreased over time. The possible presence of distal obstruction should be evaluated during surgery for GP.
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Affiliation(s)
- Keita Terui
- Department of Pediatric Surgery, Matsudo City Hospital Children's Medical Center, 4005 Kamihongo, Matsudo, Chiba, 271-8511, Japan.
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O'Hanlon KP. Gastric rupture with pneumoperitoneum after mouth-to-nose breathing in an infant. J Emerg Med 2009; 39:312-5. [PMID: 19201129 DOI: 10.1016/j.jemermed.2008.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 08/25/2008] [Accepted: 09/03/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Gastric rupture with resulting tension pneumoperitoneum occurs rarely in infants. It may be associated with resuscitative efforts. OBJECTIVES This report presents a unique case of gastric rupture and illustrates the factors necessary for prompt recognition and treatment. CASE REPORT The patient was a 16-week-old infant with nasal congestion whose father had attempted to clear her nose by a mouth-to-mouth-and-nose maneuver. The alert and attentive patient presented to the Emergency Department in respiratory distress, with marked abdominal distention. She was diagnosed with a massive tension pneumoperitoneum, which was decompressed by needle aspiration. A laceration of the lesser curvature of the stomach was repaired at laparotomy; the patient recovered uneventfully. CONCLUSION Tension pneumoperitoneum is rarely seen but has key defining elements. A simple procedure is critical to relief of the condition.
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Affiliation(s)
- Katherine P O'Hanlon
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York 14642, USA
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Lin CM, Lee HC, Kao HA, Hung HY, Hsu CH, Yeung CY, Sheu JC, Wang NL. Neonatal gastric perforation: report of 15 cases and review of the literature. Pediatr Neonatol 2008; 49:65-70. [PMID: 18947001 DOI: 10.1016/s1875-9572(08)60015-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Gastric perforation among neonates is a rare but frequently fatal condition of uncertain etiology. The aim of this study was to review the clinical course of neonatal gastric perforation and to evaluate possible prognostic factors. METHODS We retrospectively analyzed the medical records of 15 patients with neonatal gastric perforation over a 19-year period. Another 97 patients described in the medical literature, for whom the gestational ages and birth weights were clearly stated, were also reviewed. RESULTS In our series, there were three girls and 12 boys, nine of whom were full-term infants and six preterm infants. The most common initial manifestations were poor activity, abdominal distension, and respiratory distress. The overall mortality was 47% (7/15). Prematurity was the only statistically significant risk factor; 83% (5/6) of premature infants died compared with 22% (2/9) of term babies (p < 0.05). Combining our series with the patients reported in the literature, there were a total of 50 premature infants and 62 term infants. Gastric perforation occurred on postnatal days 2-7 and presented with nonspecific manifestations. The mortality was significantly higher in premature than in term infants (31/50, 62% vs. 16/62, 26%; p < 0.001). A trend towards higher mortality in infants with lower birth weights was observed (>2500 g, 28%; 1501-2500 g, 52%; 1000-1500 g, 60%; <1000 g, 100%). Infants with birth weights <2500 g had a significantly higher mortality than infants with birth weights >2500 g (32/58, 55% vs. 15/54, 28%; p<0.05). CONCLUSION Neonatal gastric perforation is associated with high mortality, particularly in premature infants. There is also a trend towards higher mortality in lower-birth-weight infants.
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Affiliation(s)
- Chieh-Mo Lin
- Department of Pediatrics, Jen-Ai Hospital, Taichung, Taiwan
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Duran R, Inan M, Vatansever U, Aladağ N, Acunaş B. Etiology of neonatal gastric perforations: review of 10 years' experience. Pediatr Int 2007; 49:626-30. [PMID: 17875089 DOI: 10.1111/j.1442-200x.2007.02427.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neonatal gastric perforation (NGP) is a rare event and its etiology is still controversial. Although it has previously been described as spontaneous, recently some risk factors have been reported to be associated with the development of NGP including prematurity and nasal ventilation. The purpose of the present paper was to report and discuss etiology, clinical features, and outcome of the authors' NGP cases over a 10 year period. METHODS Charts of five infants with NGP was reviewed in terms of gender, birthweight, gestational age, time of diagnosis, associated disease, site of perforation, type of surgery performed, and clinical outcome. RESULTS There were three boys and two girls with a mean birthweight and gestational age of 1650 g and 32 weeks, respectively. Three of them were premature. Mean perforation time was day 10 postnatally. Three infants had associated problems including prematurity, respiratory distress syndrome type 1, necrotizing enterocolitis, mechanical ventilator support, and one of them had tracheaesophageal fistula. Mothers of two out of these three infants had chorioamnionitis. One full-term infant received dexamethasone because of brain edema. Only one patient had no associated problem. Perforation occurred in the lesser curvature in three infants and in the greater curvature in two infants. Mortality rate was 60%. CONCLUSIONS Contrary to previous literature, and similar to recent publications, it was found that essentially low-birthweight infants with tracheaesophageal fistula or chorioamnionitis and full-term babies on steroid therapy may have a risk for NGP, suggesting that an infant with contributing factors should be monitored more carefully for the development of NGP.
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Affiliation(s)
- Ridvan Duran
- Department of Pediatrics, Trakya University Faculty of Medicine, Edirne, Turkey.
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Korhonen P, Helminen M, Iber T, Abram A, Tammela O. An unexpected cause of gastric perforation in a term-born neonate. Diagnosis: neonatal gastric perforation due to fungal infection. Acta Paediatr 2007; 96:600-1. [PMID: 17326756 DOI: 10.1111/j.1651-2227.2006.00227.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Päivi Korhonen
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland.
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Pasquini L, Wimalasundera RC, Fichera A, Barigye O, Chappell L, Fisk NM. High perinatal survival in monoamniotic twins managed by prophylactic sulindac, intensive ultrasound surveillance, and Cesarean delivery at 32 weeks' gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 28:681-7. [PMID: 17001748 DOI: 10.1002/uog.3811] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Increased perinatal mortality in monoamniotic twin pregnancies is attributed to cord accidents in utero and at delivery. We evaluated the following parameters in monoamniotic pregnancies: (1) the incidence of cord entanglement; (2) the effect of sulindac on amniotic fluid volume and stability of fetal lie; and (3) the perinatal outcome with our current management paradigm. METHODS This is a retrospective review of monoamniotic pregnancies of >or=20 weeks' gestation managed with serial ultrasound surveillance, medical amnioreduction and elective Cesarean delivery at 32 weeks' gestation. Mean amniotic fluid index (AFI) and change in AFI in monoamniotic pregnancies managed with oral sulindac was compared with 40 gestation-matched monochorionic-diamniotic controls. RESULTS Among 44 monoamniotic pregnancies, 20 with two live structurally normal twins at 20 weeks' gestation satisfied the inclusion criteria. All fetuses survived to 28 days postnatally despite early prenatal cord entanglement in all but one case. Whereas AFI remained stable throughout gestation in the controls, the AFI fell in those patients on sulindac from a mean value of 21.0 cm (95% CI, 18.5-23.6 cm) at 20 weeks to a mean of 12.4 cm (95% CI, 10.1-14.6 cm) at 32 weeks (ANOVA P across gestation = 0.001) but mainly remained within normal limits. Fetal lie was stabilized in 11/20 cases in the monoamniotic group compared with 13/40 in the control group (P < 0.0001). CONCLUSIONS Cord entanglement appears unpreventable, as it typically occurs in early pregnancy. Sulindac therapy reduces AFI, leads to more stable fetal lie, and may prevent intrauterine death by diminishing the risk of constricting cords that are already entangled. Perinatal survival in monoamniotic pregnancies managed by a regime of sulindac from 20 weeks' gestation, close ultrasound surveillance and elective abdominal delivery at 32 weeks' gestation seems empirically higher than that in the literature.
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Affiliation(s)
- L Pasquini
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, London, UK.
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Abstract
BACKGROUND Gastric perforation is a rare, life-threatening condition in neonates. To avoid deterioration, prompt surgical treatment is mandatory. PATIENTS We report on 2 neonates (1 and 8 days old) with feeding tube associated gastric perforation managed laparoscopically by single layer suture repair. Both children suffered from severe peritonitis. Operative time was 60 minutes in both cases. Oral feeding was started on postoperative day 3 and 7, respectively. No complications regarding the gastric perforation were encountered on follow-up (11 and 8 months, respectively) in both cases. CONCLUSIONS We recommend laparoscopic suture repair as a safe and feasible method for surgical treatment of gastric perforation in neonates. These appear to be the first reported cases using this procedure for treatment of neonatal gastric perforation.
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Affiliation(s)
- Sylvia Glüer
- Department of Pediatric Surgery, Hannover Medical School, D-30623 Hannover, Germany.
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Abstract
PURPOSE Intraabdominal foregut perforations in children are rare. We conducted a retrospective review with the aim of defining their etiologies, treatment, outcomes, and prognosis. METHODS Abdominal foregut perforations treated during a 10-year period were reviewed. Perforations secondary to blunt or penetrating trauma and inadvertent perforations sustained, recognized, and repaired during surgical procedures, were excluded. RESULTS Fourteen perforations were identified, including 1 esophageal, 8 gastric, and 5 duodenal perforations. Seven perforations (50%) occurred in the neonatal period. Of the 7 neonates, 3 (43%) were premature. Nine patients (64%) had significant comorbidities. Six (43%) perforations were spontaneous, 5 (36%) were iatrogenic, and 3 (21%) were direct complications of underlying conditions. Primary repair of the perforation was completed in 11 patients (79%), and staged repair in 1 patient. Significant morbidities related to the perforation occurred in 36% of patients. Twelve patients (86%) survived to discharge. The 10 long-term survivors are on full oral feeds. CONCLUSIONS Pediatric abdominal foregut perforations have diverse etiologies. Half occur in neonates, evenly divided between term and premature babies. Major comorbidities are common. One third are iatrogenic and potentially preventable. Primary repair should be performed when feasible. Patients who survive the initial complications have excellent long-term outcomes.
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Affiliation(s)
- Janet Abadir
- Division of Pediatric Surgery, Department of Surgery, University of California, Irvine Children's Hospital, Orange, CA 92868-3298, USA
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Im SA, Lim GY, Hahn ST. Spontaneous gastric perforation in a neonate presenting with massive hydroperitoneum. Pediatr Radiol 2005; 35:1212-4. [PMID: 16096828 DOI: 10.1007/s00247-005-1543-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Revised: 06/14/2005] [Accepted: 06/20/2005] [Indexed: 10/25/2022]
Abstract
We report the imaging findings in a case of neonatal spontaneous gastric perforation presenting as massive hydroperitoneum rather than pneumoperitoneum. Plain abdominal radiography showed a diffuse ground-glass opacity with paucity of bowel gas. Subsequent ultrasonography demonstrated numerous echogenic peritoneal fluid collections containing echogenic debris shown at surgery to be due to milk and bile.
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Affiliation(s)
- Soo Ah Im
- Kangnam St. Mary's Hospital, The Catholic University of Korea, 505, Banpo-dong Seocho-gu, Seoul, 150-701, Korea
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Morikawa N, Honna T, Kuroda T, Kitano Y, Fuchimoto Y, Terawaki K, Tanaka K, Kawashima N, Machigashira S, Matsuoka K. Lethal gastric rupture caused by acute gastric ulcer in a 6-year-old girl. Pediatr Surg Int 2005; 21:943-6. [PMID: 16151819 DOI: 10.1007/s00383-005-1523-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Gastric rupture is extremely rare in childhood beyond the neonatal period. We describe a previously healthy 6-year-old girl with a large laceration along the greater curvature on the posterior wall of the stomach. The patient was admitted to a neighboring hospital because of vertigo with 1-day history of intractable vomiting and epigastric pain. Although abdominal distension was noticed during the physical examination, muscular rigidity was not detected on palpation. Laboratory data showed severe hypotonic dehydration and moderate metabolic acidosis with hyperkalemia. She suddenly developed cardiac arrest within an hour after admission. After resuscitation, surgical consultation was obtained. Abdominal X-ray and ultrasound revealed abdominal free air and massive cloudy ascites. At laparotomy, there was a large laceration on the greater curvature of the stomach. Pathology of the gastric wall showed mucosal necrosis while the musculature remained intact consistent with an acute gastric ulcer. Since clinical condition of gastric rupture deteriorates rapidly, early diagnosis and appropriate treatment is essential for good prognosis. One should consider that ulcer formation might cause gastric rupture in childhood.
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Affiliation(s)
- Nobuyuki Morikawa
- Department of Surgery, National center for child health and development, 2-10-1 Ookura Setagaya-ku, Tokyo, 157-8535, Japan.
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[Spontaneous gastric perforation in a neonate. A case report]. Arch Pediatr 2005; 11:1067-9. [PMID: 15350996 DOI: 10.1016/j.arcped.2004.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2003] [Accepted: 05/19/2004] [Indexed: 11/25/2022]
Abstract
Gastric perforation in the neonate is rare. The authors report a 3-day-old male infant, born through a normal delivery after an uncomplicated pregnancy, who presented with a sudden gross distention of the abdomen followed by respiratory distress. Abdominal X-ray examination showed a massive pneumoperitoneum. After a brief resuscitation, an isolated perforation of the stomach was discovered on laparotomy and was sutured. Outcome of spontaneous gastric perforation in newborns is favourable provided the disease is early recognised and treated.
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Affiliation(s)
- Brian Richardson
- Department of Emergency Medicine, Wright State University School of Medicine, Dayton, OH 45429, USA
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