scholarly journals Neonatal gastric perforation: is prematurity the only cause?

2020 ◽  
Vol 7 (9) ◽  
pp. 1318
Author(s):  
Manas R. Dash ◽  
S. K. Barma ◽  
Pranay Panigrahi ◽  
P. Parida ◽  
P. K. Mohanty ◽  
...  
Keyword(s):  
Early Detection ◽  
Early Diagnosis ◽  
Gastric Perforation ◽  
Primary Repair ◽  
Surgical Care ◽  
Abdominal Distension ◽  
Anterior Wall ◽  
Care Hospital ◽  
Neonatal Gastric Perforation ◽  
Gastric Ischemia

Background: Neonatal Gastric Perforation (NGP) is a serious and life-threatening emergency and challenging in terms of diagnosis and management.  The precise aetiology remains obscure in most cases. Published literatures provide theories of gastric ischemia, aerophagia & trauma with or without definite inciting pathology.  Owing to its high mortality rate, it requires early detection & urgent intervention to bring out the newborn from this catastrophe.Methods: We report five cases of neonatal gastric perforation over period of 2013-2019 admitted to a tertiary paediatric surgical care hospital managed by early detection, prompt resuscitation along with exploration and primary repair of the defect in gastric wall.Results: The common feature in these five cases were preterm age, low birth weight, hypoxic event   and   marked abdominal distension causing respiratory distress.  Features of imminent or complete septic shock were present in all cases. Perforation was found on anterior wall along greater curvature of stomach in all babies. Four babies out of five survived except in one case of jejunoileal Artesia that developed gastric perforation in post operative period.Conclusions: Neonatal gastric perforation should be suspected in cases of rapidly deteriorating premature newborn with gross abdominal distension and pneumoperitoneum. In our opinion, etiology of NGP is multifactorial. Prematurity, low APGAR score with vigorous resuscitation could be a clue for early diagnosis. Good outcome in our series was due to early diagnosis and prompt pre and postoperative measures. Additionally, sterile gastric content in peritoneum  might lead to survival from this catastrophic event.

Neonatal Gastric Perforation: 14-Year Experience from a Tertiary Neonatal Intensive Care Unit

2021 ◽  
Author(s):  
Rishika P. Sakaria ◽  
Parul G. Zaveri
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Gastric Perforation ◽  
Retrospective Chart Review ◽  
Abdominal Distension ◽  
Neonatal Gastric Perforation

Objective Neonatal gastric perforations (NGPs) are rare and account for 7 to 12% of all gastrointestinal perforations in the neonatal period. The etiology and prognostic factors associated with NGP remain unclear. The aim of this study is to review the cases of NGP in our neonatal intensive care unit (NICU) in the past 14 years and describe the risk factors, clinical presentation, and outcomes associated with it. Study Design A retrospective chart review of neonates with gastric perforation admitted to the NICU between June 2006 and December 2020 was performed. Data regarding their antenatal and neonatal characteristics, laboratory and radiological results, intra-operative findings, hospital course, and outcomes were recorded. Results We identified 350 patients with gastrointestinal perforation at our center during the study period of which 14 (4%; nine males and five females) patients were diagnosed with NGP during surgery. A total of 71% neonates were born preterm (range: 24–39 weeks, median: 34 weeks). Two neonates (14%) were SGA. Only one neonate received cardiopulmonary resuscitation at birth. In all neonates, except two, perforation occurred within the first 10 days of life (median: 4 days, range: 1–22 days). In total, 79% infants received feeds prior to perforation. Ten neonates had a feeding tube, and one neonate had a gastrostomy tube placed prior to perforation. Abdominal distension and pneumoperitoneum were present in all neonates. Majority of the babies had metabolic acidosis (64%) and elevated C-reactive protein (79%). Most (86%) neonates received surgical intervention within 12 hours. Overall survival in our study was 93%. Conclusion NGP is a rare entity seen mostly in preterm infants within the first 10 days of life. Clinical presentation is similar to perforation anywhere along the gastrointestinal tract and definite diagnosis requires exploratory laparotomy. With prompt recognition and surgical intervention, the overall mortality related to neonatal gastric perforation is low. Key Points

scholarly journals Neonatal Gastric Perforation: Smallest Baby Ever Operated and Survived: A Case Report

2018 ◽  
Vol 7 (2) ◽  
pp. 24
Author(s):  
Nikhilesh Nain ◽  
Sunil Janged
Keyword(s):  
Gastric Perforation ◽  
Partial Gastrectomy ◽  
Abdominal Distension ◽  
Operative Management ◽  
Invasive Ventilation ◽  
X Ray ◽  
Neonatal Gastric Perforation ◽  
Gastric Decompression ◽  
Greater Curvature ◽  
Prompt Diagnosis

Neonatal gastric perforation is a rare surgical emergency with no certain etiology. Due to its high mortality prompt diagnosis and emergency exploration surgery is mandatory. Hereby, we report a case of neonatal gastric perforation in a 4-day-old extreme low birth weight baby (645 g) born at 29 weeks who presented with complaints of abdominal distension, lethargy, and respiratory distress. X-ray abdomen revealed free gas under the diaphragm. Emergency surgery was performed. On exploration, a tear was seen along the greater curvature of the stomach with necrotic walls. Partial gastrectomy was done and perforation closed. Postoperatively baby was managed with invasive ventilation, IV antibiotics, parenteral nutrition, and continuous gastric decompression by nasogastric tube. Baby survived with intensive post-operative management and was discharged after 90 days of NICU stay. As far as literature is concerned this is the case of a smallest baby ever operated and survived after neonatal gastric perforation.

Gastric Ischemia: The Primary Factor in Neonatal Perforation

1973 ◽  
Vol 12 (4) ◽  
pp. 219-225 ◽  
Author(s):  
ROBERT J. Touloukian
Keyword(s):  
Gastric Perforation ◽  
Perinatal Asphyxia ◽  
Primary Factor ◽  
New Haven ◽  
Perinatal Complications ◽  
Contributing Factors ◽  
Neonatal Gastric Perforation ◽  
Gastric Musculature ◽  
Gastric Ischemia ◽  
Haven Hospital

The incidence of perinatal asphyxia and evidence for gastric ischemia were investigated in six patients from the Yale-New Haven Hospital and 87 previously reported cases having neonatal gastric perforation. All our patients and 69 per cent of the collected series were found to have significant perinatal complications predisposing to asphyxia; five of our patients and 41 per cent of those reviewed had evidence of gastric ischemia as manifested by mucosal hemorrhage, ulceration, or necrosis. Gastric ischemia is the primary factor in neonatal perforation although pneumatic distention with separation of the gastric musculature, the effects of the acid pepsin response on the gastric mucosa, and direct trauma to the stomach wall are important contributing factors which make gastric perforation unique.

scholarly journals Neonatal Sleeve Gastrectomy for Multiple Gastric Perforations: A Case Report

2016 ◽  
Vol 6 (1) ◽  
pp. 10 ◽  
Author(s):  
Francisco Reyna-Sepulveda
Keyword(s):  
Sleeve Gastrectomy ◽  
Case Report ◽  
Necrotizing Enterocolitis ◽  
Gastric Perforation ◽  
Primary Repair ◽  
Neonatal Gastric Perforation ◽  
Distal Obstruction ◽  
Greater Curvature

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.

scholarly journals Gastric Perforation in Ndola- Zambia: A Case Report

2018 ◽  
Vol 3 (7) ◽  
Keyword(s):  
Poor Prognosis ◽  
Gastric Perforation ◽  
Rare Event ◽  
The Elderly ◽  
Anterior Wall ◽  
Abdominal Pressure ◽  
Free Perforation ◽  
Neonatal Gastric Perforation ◽  
Inflammatory Drugs ◽  
Lesser Curvature

It is known that there is problem of gastric perforation (GP) in Africa, in the Japanese and the Western countries. However it occurs much less frequently [1,2]. Some cases have been free perforation and some have been major bleeding in patients with gastric cancer. Perforations are serious conditions with potentially dangerous effects however they are rare [3]. There is also evidence that neonatal gastric perforation (GP) does occur but it is a very rare event. It is associated with a poor prognosis and there is still much debate about its etiology [4]. It is believed that the perforation occurs in the lesser curvature and anterior wall of the stomach. Some authors think that gastric Perforation (GP), is caused by a mechanical rupture of the stomach wall, as a result of increased intragastric pressure, in adults, full-term and premature infants [5]. There is also a theoretical concern that the capnoperitoneum (Increased intra-abdominal pressure 10-12mmHg), may aggravate peritonitis and induce septic shock. It is associated with a poor prognosis [6]. The Gastric perforation is also seen that one of four ulcer perforations can be attributed to the use of nonsteroidal anti-inflammatory drugs, a risk factor of particular in the elderly [2]. In peptic ulcer or gastric perforation, Endoscopy and or Laparoscopy are being increasingly used in conditions even though there is complication of peritonitis [7-9].

scholarly journals Changing clinical profile of malaria at a tertiary care hospital

2018 ◽  
Vol 5 (3) ◽  
pp. 510
Author(s):  
Shital N. Rathod ◽  
Arvind Chavan ◽  
Shilpa Sharma ◽  
Tushar Rathod ◽  
Nihal Khan ◽  
...  
Keyword(s):  
Early Detection ◽  
Early Diagnosis ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Peripheral Smear ◽  
Clinical Pattern ◽  
Atypical Symptoms ◽  
Atypical Manifestations ◽  
High Degree

Background: There is a widespread range of diverse typical and atypical manifestations of malaria. The diagnosis of malaria may escape the attention of treating physician due to its unusual and vague presentations.The morbidity and mortality due to malaria is increased due to lack of early diagnosis and right treatment. The Aim of the present study was to examine the changing clinical pattern of malaria with special attention to atypical presentations.Methods: The present study comprised of 630 cases of definitively diagnosed malaria.Diagnostic methods used were conventional thick and thin peripheral smear stained with Leishman stain and rapid malarial antigen test.Results: This study revealed atypical symptoms like lack of taste (1.3%), throat discomfort (13.33%) and cough (24.0%) and vomiting (52.4%) as presenting complaints. These were significantly more in patients with P. vivax infestations.Conclusions: A high degree of suspicion is necessary for early detection and treatment of malaria, especially of unusual presentations.

scholarly journals Spontaneous Gastric Perforation in Neonates: A Tertiary Pediatric Surgical Center Experience

2019 ◽  
Vol 8 (3) ◽  
pp. 20
Author(s):  
Abdelghany EM Abdelgawad ◽  
Ahmed A Darwish ◽  
Emely Hughes ◽  
Eleri Cusick
Keyword(s):  
Gastric Perforation ◽  
Primary Repair ◽  
Ductus Arteriosus ◽  
Rare Condition ◽  
Abdominal Distension ◽  
Posterior Wall ◽  
Tertiary Hospital ◽  
Early Postoperative Period ◽  
Preterm Neonates ◽  
Greater Curvature

Objective: To report our experience with spontaneous neonatal gastric perforation (SNGP) in a tertiary hospital over the last 9 years.Methods: Retrospective review of neonates with SNGP treated in Bristol Royal Hospital for Children between January 2010 and December 2018 was performed. Data retrieved included demography, perinatal clinical details, operative data, and outcome. Cases with esophageal atresia, necrotizing enterocolitis or distal obstruction were excluded.Results: Of 13 cases, 4 were males and 9 females. Two neonates were full term; while 11 were preterm with median gestational age of 28 weeks. Abdominal distension and metabolic acidosis were mostly found in these patients. Patent ductus arteriosus was encountered in 53.8% of the patients. The most common site of perforation was the greater curvature (38.4%) followed by posterior wall (30.8%) of the stomach. Primary repair was performed in all cases. One neonate developed recurrent perforation in the early postoperative period. Five preterm (38.5%) neonates succumbed in our series.Conclusion: SNGP is a rare condition increasingly diagnosed in preterm neonates. Greater curvature and posterior wall of stomach are commonly involved. Despite recent advances in intensive care, the prognosis is still poor in preterm babies with multiple associated problems.

Transillumination in neonatal gastric perforation

2021 ◽  
Vol 57 (5) ◽  
pp. 757-757
Author(s):  
Yi‐Li Hung ◽  
Chun‐Min Shen ◽  
Wu‐Shiun Hsieh
Keyword(s):  
Gastric Perforation ◽  
Neonatal Gastric Perforation

scholarly journals Developing of a Simple Screening Tool for Opportunistic COPD Case Finding

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
Y M Mohamed ◽  
S H Sharkawy ◽  
D I Darwish
Keyword(s):  
High Risk ◽  
Early Detection ◽  
Early Diagnosis ◽  
Outpatient Clinic ◽  
World Wide ◽  
Screening Tool ◽  
Case Finding ◽  
Screening Questionnaire ◽  
Risk Patients ◽  
Simple Screening

Abstract Background Under diagnosis of COPD is serious problem in many countries world-wide because there are no generally detection tools available to detect high-risk patients for spirometry, and patients will not go for COPD check-up until a serious issue happens like exacerbation. Objective The aim of the work is trying to assess a new screening tool for early diagnosis of COPD. Patients and Methods The present study was conducted upon 500 subjects during the period from march 2018 to august 2018 who admitted to our chest department or visit our outpatient clinic, employees and visitors to Ain Sham hospitals.All subjects >40yrs who smoker or ex-smoker(≥10pack-years) applied a six variants(age,sex,packed years smoked during life ,dyspnea,chronic phlegmand chronic cohgh)questionnaire modified from PUMA questionnaire Subjects with score ≥5 did spirometry Results 500 subjects shared in the study 497 of them were males ( 99.4% )and 3 were females (.6%). 152of them(30.4%) had score <5 and 348 of them (69.6%)had score ≥5 who did spirometry.152 subjects did not perform spirometry. By spirometry we diagnosed 81(23.3) case COPD (fev1-fvc <.7) out of 348 subjects under gone spirometry and 16.2% of total subjects(500) . Conclusion Modified puma score is a simple and easy screening questionnaire for early detection of COPD cases and spirometry should be done to confirm the diagnosis or rule out.COPD is prevalent in many healthy apparent persons.

scholarly journals Experimental Ehrlichia canis infection changes acute-phase proteins

2012 ◽  
Vol 21 (3) ◽  
pp. 206-212 ◽  
Author(s):  
Thiago Demarchi Munhoz ◽  
Joice Lara Maia Faria ◽  
Giovanni Vargas-Hérnandez ◽  
José Jurandir Fagliari ◽  
Áureo Evangelista Santana ◽  
...  
Keyword(s):  
Early Detection ◽  
Early Diagnosis ◽  
Acute Phase ◽  
Acute Phase Proteins ◽  
Ehrlichia Canis ◽  
Laboratory Findings ◽  
Early Detection Of Disease ◽  
Acid Glycoprotein ◽  
The Third ◽  
Canine Ehrlichiosis

Early diagnosis of canine ehrlichiosis favors prompt institution of treatment and improves the prognosis for the animal, since this disease causes mortality among dogs. Studies have shown that determining the concentration of acute-phase proteins (APPs) may contribute towards early detection of disease and aid in predicting the prognosis. This study aimed to evaluate the APP profile in dogs experimentally infected with Ehrlichia canis, at the start of the infection and after treatment. It also investigated whether any correlation between APP levels and the clinical and laboratory alterations over the course of the disease would be possible. The results obtained showed abnormal levels of all the APPs on the third day after infection (D3), with the highest levels being reached on D18, with the exception of ceruloplasmin and acid glycoprotein, which presented their peaks on D6 and D12 respectively. We concluded that assessment of APP levels could contribute towards establishing an early diagnosis of canine ehrlichiosis, particularly regarding acid glycoprotein and ceruloplasmin, since these proteins were detected at increased levels even before the onset of clinical and laboratory findings of the disease.

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