‘Spontaneous’ neonatal gastric perforation: Is it really spontaneous?☆
Section snippets
Materials and methods
A retrospective review was conducted of 7 cases of gastric perforation seen over a 16-year period on the neonatal and pediatric surgical service of UMDNJ-Robert Wood Johnson Medical School. There were approximately 84,000 live births during this period. The babies were all cared for in the neonatal intensive care nursery at Saint Peter's University Hospital, and diagnosis was made by a radiograph that showed pneumoperitoneum. Gastric perforation was diagnosed at operation, with the preoperative
Results
Table 1 outlines the essential findings in these 7 pa-tients. Four of our babies were full term (2,200 to 3,630 g). Case No. Date of Birth Sex Age (wk) Weight (g) C- Section Associated Problems Day of Life Perforation Location of Gastric Perforation Repair of Perforation Gastrostomy Maternal Complications Fetal Complications CPAP Intubated Survival 1 10/09/81 M 39 2,200 Yes Peritonitis, sepsis 3 1.5-2 cm posterior lesser curvature 3-layer silk closure Yes None Anemia, Hct 33
Discussion
Neonatal gastric perforation was thought to occur spontaneously1, 2, 3, 4, 5, 6 without any associated gastrointestinal conditions and was originally thought to be caused by a congenital absence of gastric musculature.1, 2, 3 Shaw et al7 suggested that gastric perforation was caused by mechanical rupture of the stomach secondary to increased gastric pressure rather than a congenital agenesis of gastric muscle. In more recent reports8, 9, 10, 11, 18 prematurity was shown to be a common finding
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Cited by (81)
Structural Anomalies of the Gastrointestinal Tract
2023, Avery's Diseases of the NewbornWatch your numbers! Avoiding gastric perforation from feeding tubes in neonates
2021, Pediatrics and NeonatologyTotal gastrectomy with delayed Hunt-Lawrence pouch reconstruction for neonatal gastric perforation presenting with hematemesis
2020, Journal of Pediatric Surgery Case ReportsCitation Excerpt :Several risk factors of neonatal gastric perforation have been identified in the literature. The most commonly cited factor is gastric distension due to positive pressure ventilation via orotracheal intubation or CPAP [2,12]. Other proposed causes include perinatal hypoxia resulting in ischemia to the stomach [13], immature esophageal and gastric peristaltic coordination resulting in increased gastric pressures [1], vasculopathy or thrombosis within the blood vessels supplying the stomach [7], and the use of indomethacin for congenital heart disease [8] or steroids for neonatal respiratory distress syndrome [4].
Pediatric gastric perforation beyond neonatal period: 8-year experience with 20 patients
2019, Pediatrics and NeonatologyCitation Excerpt :Large amounts of studies have explored neonatal gastric perforation, which has been characterized5,6 as onset within the first week of age and is complicated with alimentary malformations. The mortality is up to 30%–70%,7–10 and the most common cause is congenital gastric muscular wall defects. However, gastric perforation in pediatric patients beyond the neonatal period has rarely been reported, and they have different characteristics from neonatal patients.
Neonatal gastric necrosis and perforation associated with impacted medication
2019, Journal of Pediatric Surgery Case ReportsCitation Excerpt :There are many etiologies of neonatal gastric perforation, including C-KIT + mast cell deficiency [2], congenital agenesis of gastric muscle [3], lack of intestinal pacemaker cells [4], high gastric acidity and ulceration [5], infection [6], and distal obstruction [7]. Additionally, there have also been medical causes reported including traumatic intubation [8], nasal ventilation [9,10], corticosteroid administration [11], and cry so hard after operation [12]. In addition, bezoars resulting from the ingestion of bananas [13] and milk curd [14], as well as from medical substances, such as cation exchange resins, have also been reported as a cause of gastric perforation.
Structural Anomalies of the Gastrointestinal Tract
2018, Avery's Diseases of the Newborn: Tenth Edition
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Address reprint requests to Irwin H. Krasna, MD, Division of Pediatric Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08903-0019.