gms | German Medical Science

Background: Neonatal Gastric perforation (NGE) remains a quite rare but difficult surgical challenge. While there is no relieable data about the incidence of NGE, the range of mortality varies from ~25% up to ~60% in several reviews. The exact etiology still remains unclear. Besides iatrogenic perforation by usage of nasal ventilation or application of corticosteroids, other factors like prematurity, asphyxia, necrotizing enterocolitis (NEC), eosphageal atresia and distal gastrointestinal obstruction have been reported to be associated with gastric perforation.

Materials and methods: We report of 3 cases of boys with gastric perforation placing special focus on gestational age, birthweigth, timepoint of diagnosis, additional diseases and clinical outcome.

Results: Patient 1: A preterm boy (gestational week 28+5) with birth-weight of 1290 g, suffering esophageal atresia type IIIb (Vogt) and postnatal cardiopulmonary reanimation. On the first day ligation of the tracheoesophageal fistula and creation of gastric stoma. On day 4 radiography was showing a pneumoperitoneum. Following laparotomy showed a gastric perforation which was located in the dorsal gastroesophageal junction. Suture of the gastric wall and closure of the perforation. The esophageal atresia could be healed by anastomosis after intervention using foker-technique. Today the patient is developing well but dealing with stenosis of the esophageal anastomosis.

Patient 2: A preterm boy (gestational week 29+6) with birth-weight of 540 g. On day 5 after birth a pneuperitoneum occured and laparatomy showed a complete rupture of the gastric wall along the great curvature. First we tried to do a reconstruction of the gastric wall. On day 8 abdominal distension and pneumoperitoneum was seen again. This time laparotomy showed a chemical peritonitis with multiple focal perforations from distal esophagus to pylorus. We decided to perform a complete gastrectomy. Afterwards good recovery. Stagnation in gaining weight.

Patient 3: A preterm boy (gestational week 26+1) with birth-weight of 640 g with recurrent gastroinstestinal perforations. On day 2 massive pneumoperitoneum and following laparatomy showing multiple intestinal perforations in proximal ileum and atretic terminal ileum. On day 6 again pneumoperitoneum and re-laparoscopy showing gastric perforation along minor curvature measuring 15 mm. Closure of perforation and creation of gastric stoma. On day 12 a re-laparoscy had to be performed showing an additional gastric rupture along the greater curvature and surgical managment by suturing.

Conclusion: Neonatal gastric perforation demands an optimal cooperation of neonatal intensive care units, radiologists and pediatric surgeons. Prematurity, low birth weight, esophageal atresia and distal obstruction seem to be very important risk factors. Although gastric perforation is associated with high mortality rates all patients of this case report survived.