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.

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 Spontaneous gastric perforation: is it really common?

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Imran Hashim ◽  
Nabila Talat ◽  
Asif Iqbal ◽  
Muhammad Saleem Choudhary ◽  
Naveed Haider ◽  
...  
Keyword(s):  
Gastric Perforation ◽  
Early Recognition ◽  
Exploratory Laparotomy ◽  
Burst Abdomen ◽  
Feeding Jejunostomy ◽  
Neonatal Gastric Perforation ◽  
Threatening Condition ◽  
Life Threatening ◽  
Greater Curvature ◽  
Lesser Curvature

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.

scholarly journals Gastric perforation resulting into pneumoperitoneum in a neonate: a case report

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Jay Lodhia ◽  
David Msuya ◽  
Rune Philemon ◽  
Adnan Sadiq ◽  
Alex Mremi
Keyword(s):  
Surgical Intervention ◽  
Gastric Perforation ◽  
Abdominal Distension ◽  
Positive Outcome ◽  
Emergency Laparotomy ◽  
Routine Practice ◽  
X Ray ◽  
Stomach Body ◽  
Anterior Aspect ◽  
Inflammatory Processes

Abstract Gastric perforation in a neonate is a rare surgical emergency in routine practice. The causes and predisposing factors for gastric perforation in a neonate vary from traumatic to benign conditions like inflammatory processes. Early detection, intensive care, stabilization and prompt surgery yield positive outcome. Early diagnosis is important for better prognosis. Simple investigation such as plain abdominal X-ray can adequately lead to the diagnosis by showing pneumoperinoneum. We present a 3-day-old neonate; born at term who presented with abdominal distension and vomiting. Plain abdominal X-ray revealed pneumoperitoneum. Emergency laparotomy was performed where a gastric perforation was found measuring 0.5 by 0.5 cm located on the anterior aspect of the stomach body near the pylorus. The baby underwent successful surgical intervention and recovered well.

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 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 Diagnosing gastric volvulus in chest X-ray: report of three cases

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Narendra Pandit ◽  
Abhijeet Kumar ◽  
Tek Narayan Yadav ◽  
Qamar Alam Irfan ◽  
Sujan Gautam ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Abdomen ◽  
Gastric Volvulus ◽  
X Ray ◽  
Pain Abdomen ◽  
Life Threatening ◽  
Chest X Ray ◽  
High Index Of Suspicion ◽  
Specific Symptoms ◽  
Prompt Diagnosis

Abstract Gastric volvulus is a rare abnormal rotation of the stomach along its axis. It is a surgical emergency, hence requires prompt diagnosis and treatment to prevent life-threatening gangrenous changes. Hence, a high index of suspicion is required in any patients presenting with an acute abdomen in emergency. The entity can present acutely with pain abdomen and vomiting, or as chronic with non-specific symptoms. Chest X-ray findings to diagnose it may be overlooked in patients with acute abdomen. Here, we report three patients with gastric volvulus, where the diagnosis was based on the chest X-ray findings, confirmed with computed tomography, and managed successfully with surgery.

Outcomes of full-term infants with bilious vomiting: observational study of a retrieved cohort

2014 ◽  
Vol 100 (1) ◽  
pp. 14-17 ◽  
Author(s):  
Syed Mohinuddin ◽  
Pankaj Sakhuja ◽  
Benjie Bermundo ◽  
Nandiran Ratnavel ◽  
Stephen Kempley ◽  
...  
Keyword(s):  
Posterior Probability ◽  
Abdominal Distension ◽  
Clinical Findings ◽  
Likelihood Ratios ◽  
Term Infants ◽  
X Ray ◽  
Bilious Vomiting ◽  
Term Newborns ◽  
Time Critical ◽  
Surgical Condition

Bilious vomiting in a neonate may be a sign of intestinal obstruction often resulting in transfer requests to surgical centres. The aim of this study was to assess the use of clinical findings at referral in predicting outcomes and to determine how often such patients have a time-critical surgical condition (eg, volvulus, where a delay in treatment is likely to compromise gut viability).Methods4-year data and outcomes of all term newborns aged ≤7 days with bilious vomiting transferred by a regional transfer service were analysed. Specificity, sensitivity, likelihood ratios, correlations, prior and posterior probability of clinical findings in predicting newborns with surgical diagnosis were calculated.ResultsOf 163 neonates with bilious vomiting, 75 (46%) had a surgical diagnosis and 23 (14.1%) had a time-critical surgical condition. The diagnosis of a surgical condition in neonates with bilious vomiting was significantly associated with abdominal distension (χ2=5.17, p=0.023), abdominal tenderness (χ2=5.90, p=0.015) and abnormal abdominal X-ray findings (χ2=5.68, p=0.017) but not with palpation findings of a soft as compared with a tense abdomen (χ2=3.21, p=0.073). Abnormal abdominal X-ray, abdominal distension and tenderness had 97%, 74% and 62% sensitivity, respectively, with regard to association with an underlying surgical diagnosis. Normal abdominal X-ray reduced the posterior probability of surgical diagnosis from 50% to 16%. Overall, clinical findings at referral did not differentiate between infants with or without surgical or time-critical condition.ConclusionsWe recommend that term neonates with bilious vomiting referred for transfer are prioritised as time critical.

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