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.

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.

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 Intussusception in preterm neonates: A systematic review of a rare condition

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mostafa Kotb ◽  
Mostafa Abdelatty ◽  
Hayssam Rashwan ◽  
Yasmine AbdelMeguid ◽  
Ahmed Elrouby
Keyword(s):  
Systematic Review ◽  
Neonatal Intensive Care ◽  
Case Reports ◽  
Case Series ◽  
Rare Condition ◽  
Abdominal Distension ◽  
Contrast Enema ◽  
Preterm Neonates ◽  
Lead Point ◽  
High Index Of Suspicion

Abstract Background While necrotizing enterocolitis (NEC) is a prevalent condition in preterm neonates admitted to neonatal intensive care unit (NICU), intussusception is exceedingly uncommon and often overlooked. This is due to the fact that they share many clinical characteristics. The initial misdiagnosis of intussusception in preterm neonates (IPN) especially has led to a delay in their management, which increases the risk of developing compromised bowel. Additionally, it is difficult to reach a diagnosis as neonatal intussusception does not have any classical radiological signs even when contrast enema is used. This systematic review is based on the published literature including case reports and case series to review the clinical features of IPN and how to differentiate it from NEC in order to shed the light on this rare disease and how having a high index of suspicion would help practitioners to make an early and accurate diagnosis Methods A systematic literature search to report all cases of relevant articles that reported IPN till date. All cases that were born before 37 weeks gestational age, presented within the neonatal period and having well established documentation were included in the study. Any case that did not have these criteria was excluded from our study. Results Only 52 cases met these criteria during the period from 1963 till date. An average of 10 days had elapsed before the cases were confirmed to have IPN either clinically or intraoperatively. The most frequent manifestations were abdominal distension and bilious gastric residuals, occurring in 85% and 77% of the cases respectively, followed by bloody stools in 43% of cases. However, this triad was present only in approximately one-third of the cases. Only 13 cases were diagnosed as having intussusception preoperatively. About two thirds of the intussusception were located in the ileum. Pathological lead point was present in 7 cases only; 4 of them were due to Meckel’s diverticulum. Nine cases only out of the 52 cases with IPN died. Conclusion It is crucial to detect the clues for diagnosis of intussusception because in contrast to NEC, it is unresponsive to conservative management, affects the viability of the bowel and surgery is essential.

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.

Comparison of Prophylaxis and Rescue Treatment With Curosurf in Neonates Less than 30 Weeks' Gestation: A Randomized Trial

PEDIATRICS ◽  
1993 ◽  
Vol 92 (6) ◽  
pp. 768-774 ◽  
Author(s):  
Johannes Egberts ◽  
J. Peter de Winter ◽  
Gunnar Sedin ◽  
Martin J.K. de Kleine ◽  
Ulf Broberger ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Gestational Age ◽  
Periventricular Leukomalacia ◽  
Ductus Arteriosus ◽  
Expectant Management ◽  
Supplemental Oxygen ◽  
Preterm Neonates ◽  
Transcutaneous Oxygen ◽  
Prophylaxis Group ◽  
Rescue Treatment

Objective. The aim of this randomized clinical trial was to evaluate the immediate effects of prophylactic administration of Curosurf and to compare outcomes after prophylactic or expectant management. Study design. Porcine surfactant (Curosurf, 200 mg/kg body weight) was administered intratracheally within 10 minutes of birth to preterm neonates with a gestational age of 26 to 29 weeks (n = 75); rescue-eligible neonates (n = 72) were initially subjected to a sham maneuver. The primary end points of the trial, evaluated at the age of 6 hours, were to obtain (1) a 40% decrease in the ratio between transcutaneous oxygen tension (tcPo2) (kPa) and fraction of inspired oxygen (Fio2), and (2) a 50% decrease in the incidence of radiologically verified respiratory distress syndrome (RDS). After 6 to 24 hours, a similar dose of surfactant was given to the neonates of both the prophylaxis and the rescue-eligible group, if they needed mechanical ventilation with an Fio2 ≥ 0.6. Results. At 6 hours the prophylaxis group had, in comparison with the rescue-eligible group, significantly higher tcPo2/Fio2 ratios (mean ± SD: 39.7 ± 15.3 vs 28.1 ± 18.1; P < .001) and less severe RDS by radiological scoring (χ2 = 14.9; P = .005). Severe RDS was present in 19% of the prophylactically treated neonates versus 32% in the rescue-eligible group (P < .05). The prophylaxis group needed shorter periods of Fio2 > 0.40 than the rescueeligible neonates (P < .01), and eight neonates of the prophylaxis group (11%) versus 23 of the rescue-eligible group (32%) qualified for rescue treatment with surfactant in the interval 6 to 24 hours (P < .01). There were no differences in the incidence or severity of pneumothorax, pulmonary interstitial emphysema, cerebral hemorrhage, periventricular leukomalacia, patent ductus arteriosus, in the duration of mechanical ventilation or time in supplemental oxygen, or in mortality. Conclusions. Subgroup analysis revealed (1) that administration of corticosteroids reduced the risk of developing neonatal RDS as effectively as did surfactant prophylaxis at birth, and (2) that prophylaxis was effective especially in neonates with gestational age <28 weeks or birth weight <1000 g, in male neonates, and in neonates who had received no antenatal treatment with corticosteriods. Our data indicate that prophylactic treatment with surfactant should be considered in high-risk neonates fulfilling these latter criteria.

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