Term Male baby with no h/o birth asphyxia presented on Day 2 of life with multiple vomittings, dehydration, decreased urine output and shock. Baby responded to fluid resusitation and inotropes but he developed abdomen distenston on Day 3 with distress, requiring ventilatory support. Abdomen X-Ray showed free gas under both domes of diaphragm and stomach bubble not distinctly seen. Flank drains were placed and Exploratory Laparotopy was done. Intraop findings were:-
Gastric perforation along the greater curvature and anterior wall, length of 8cm. Free fluid and air present in peritoneal cavity. Gastric wall debridement was done and repair was done in 2 layers. Child showed good recovery in postâ€”op period. Feeds were started on Day 7 which the baby tolerated well.
Discussion:- Gastric Perforation in newborn, was described in 1825.
Proposed Etiology is:- *The perinatal risk factors include
- Traumatic -Prematurity , PROM
- Ischemic -Respiratory distress
- Spontaneous -Asphyxia and Resuscitation
Most commonly perforation is linear tear along the greater curvature on the anterior wall, size ranging from 0.5cm â€” 8cm. In this case it was approximately 8-9cm length.
They usually present between Day 2 to Day 7 of life wh sudden onset abdomen distension and respiratory distress.it X-Ray abdomen showed pneumoperitoneum (saddlebag appearance) Prompt surgical treatment and repair is recommended Any delay leads to high mortality.