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Case Reports
. 2024 Jul:120:109877.
doi: 10.1016/j.ijscr.2024.109877. Epub 2024 Jun 6.

A case report of spontaneous gastric perforation in a premature and low-birth weight neonate

Bradley Guidry  1 , Christopher Prien  2 , Kyle J Glithero  3 , Lynn Model  3 , Daniel Hechtman  3
Affiliations
Case Reports

A case report of spontaneous gastric perforation in a premature and low-birth weight neonate

Bradley Guidry et al. Int J Surg Case Rep. 2024 Jul.

Abstract

Introduction: Spontaneous gastric perforation of the neonate is a rare phenomenon with a high risk of mortality. Despite an uncertain etiology, an association with prematurity and low-birth weight has been demonstrated. Prompt surgical repair and intensive care remain imperative to survival.

Presentation of case: A premature, low-birth weight male was born at 32 weeks and admitted to the NICU for respiratory distress syndrome. Forty-eight hours after birth he developed abdominal distention and an abdominal radiograph demonstrated pneumoperitoneum. Antibiotics were initiated and he was taken for emergent operative exploration. A 3 cm longitudinal perforation was identified in the greater curvature of the stomach. A two-layered repair was performed and a protective Stamm gastrostomy created. On postoperative day 10, an upper gastrointestinal contrast study demonstrated no evidence of leakage. After sustained clinical improvement, the initiation of oral feeding, and continued weight gain, the neonate was successfully discharged home.

Discussion: The etiology of spontaneous gastric perforation remains a debate with several proposed mechanisms. In most cases, the neonate will present with abdominal distention and emesis. Although presentation and evidence of pneumoperitoneum on abdominal radiograph are suspicious for this pathology, definitive diagnosis is confirmed during operative exploration. Dedicated intensive care and prompt surgical repair are paramount to survival. Despite decreasing mortality rates, premature and low-birth weight neonates continue to have the lowest rates of survival.

Conclusion: We present a rare case of a premature, low-birth weight neonate who developed spontaneous gastric perforation and was successfully rescued using a coordinated multidisciplinary approach enabling prompt diagnosis and surgical repair.

Keywords: Case report; Gastrorrhaphy; Low-birth weight; Prematurity; Spontaneous gastric perforation; Stamm gastrostomy.

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Conflict of interest statement

Conflict of interest statement The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Abdominal radiograph demonstrating significant pneumoperitoneum.
See this image and copyright information in PMC

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