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Case 1:- Acute Gastric Perforation

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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 post—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 — 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.