‘Spontaneous’ neonatal gastric perforation: Is it really spontaneous?

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Abstract

Background/Purpose: Most historical reports have described gastric perforation in the neonatal population as “spontaneous.” More recently, several variables, including prematurity and nasal ventilation, have been implicated as contributing factors. The authors sought to analyze the etiology, course, and outcome of newborns with spontaneous gastric perforation from one institution over a 16-year period. Methods: The authors reviewed retrospectively the charts of all infants who underwent operation or had perforation of the stomach diagnosed in the newborn period. Results: Among more than 84,000 live births, 7 newborns were identified with perforation of the stomach. Four had coexisting gastrointestinal lesions (2 necrotizing enterocolitis, 1 undiagnosed tracheoesphageal fistula, 1 meconium plug), and 1 received nasal continuous positive airway pressure (CPAP). In only 2 cases were no other gastrointestinal lesions or other presumed contributing factors (nasal CPAP) present, and thus, only 2 cases could be classified as “spontaneous.” Mortality rate was 57%. Three of the patients were premature, all of whom died. Conclusions: Whereas in the older literature, most cases of gastric perforation were considered spontaneous, and were full term, the authors' review of 7 cases over a 16-year period leads us to question the cause as spontaneous. The authors found that prematurity and concomitant gastrointestinal lesions were associated with gastric perforation in the neonate and that few cases truly are spontaneous. The authors suggest that when gastric perforation occurs in neonates, a contributing cause should be sought. J Pediatr Surg 35:1066-1069. Copyright © 2000 by W.B. Saunders Company.

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).

. Findings in 7 Patients With Gastric Perforation

Case No. Date of BirthSexAge (wk)Weight (g)C- SectionAssociated ProblemsDay of Life PerforationLocation of Gastric PerforationRepair of PerforationGastrostomyMaternal ComplicationsFetal ComplicationsCPAPIntubatedSurvival
1 10/09/81M392,200YesPeritonitis, sepsis31.5-2 cm posterior lesser curvature3-layer silk closureYesNoneAnemia, 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

References (20)

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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.

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