PDF herunterladen
Am J Perinatol 2023; 40(10): 1112-1118
DOI: 10.1055/s-0041-1733780
Original Article

Neonatal Gastric Perforation: 14-Year Experience from a Tertiary Neonatal Intensive Care Unit

Rishika P. Sakaria 
1   Division of Neonatology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
,
Parul G. Zaveri 
1   Division of Neonatology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
› Institutsangaben Funding None.
› Weitere Informationen
    Lizenzen und Reprints

Abstract

Objective Neonatal gastric perforations (NGPs) are rare and account for 7 to 12% of all gastrointestinal perforations in the neonatal period. The etiology and prognostic factors associated with NGP remain unclear. The aim of this study is to review the cases of NGP in our neonatal intensive care unit (NICU) in the past 14 years and describe the risk factors, clinical presentation, and outcomes associated with it.

Study Design A retrospective chart review of neonates with gastric perforation admitted to the NICU between June 2006 and December 2020 was performed. Data regarding their antenatal and neonatal characteristics, laboratory and radiological results, intra-operative findings, hospital course, and outcomes were recorded.

Results We identified 350 patients with gastrointestinal perforation at our center during the study period of which 14 (4%; nine males and five females) patients were diagnosed with NGP during surgery. A total of 71% neonates were born preterm (range: 24–39 weeks, median: 34 weeks). Two neonates (14%) were SGA. Only one neonate received cardiopulmonary resuscitation at birth. In all neonates, except two, perforation occurred within the first 10 days of life (median: 4 days, range: 1–22 days). In total, 79% infants received feeds prior to perforation. Ten neonates had a feeding tube, and one neonate had a gastrostomy tube placed prior to perforation. Abdominal distension and pneumoperitoneum were present in all neonates. Majority of the babies had metabolic acidosis (64%) and elevated C-reactive protein (79%). Most (86%) neonates received surgical intervention within 12 hours. Overall survival in our study was 93%.

Conclusion NGP is a rare entity seen mostly in preterm infants within the first 10 days of life. Clinical presentation is similar to perforation anywhere along the gastrointestinal tract and definite diagnosis requires exploratory laparotomy. With prompt recognition and surgical intervention, the overall mortality related to neonatal gastric perforation is low.

Key Points

  • Neonatal gastric perforation is a rare but life threatening entity with unclear etiology.

  • Prematurity is associated with an increased incidence of gastric perforations in the neonate.

  • Laparotomy is required for definitive diagnosis and treatment.

Keywords

neonate - pneumoperitoneum - lactobezoar - gastric perforation


Publikationsverlauf

Eingereicht: 12. Mai 2021

Angenommen: 23. Juni 2021

Artikel online veröffentlicht:
29. Juli 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Grosfeld JL, Molinari F, Chaet M. et al. Gastrointestinal perforation and peritonitis in infants and children: experience with 179 cases over ten years. Surgery 1996; 120 (04) 650-655 , discussion 655–656
    CrossrefPubMedGoogle Scholar
  • 2 Asabe K, Oka Y, Kai H, Shirakusa T. Neonatal gastrointestinal perforation. Turk J Pediatr 2009; 51 (03) 264-270
    PubMedGoogle Scholar
  • 3 St-Vil D, LeBouthillier G, Luks FI, Bensoussan AL, Blanchard H, Youssef S. Neonatal gastrointestinal perforations. J Pediatr Surg 1992; 27 (10) 1340-1342
    CrossrefPubMedGoogle Scholar
  • 4 Inouye WY, Evans G. Neonatal gastric perforation. A report of six cases and a review of 143 cases. Arch Surg 1964; 88: 471-485
    CrossrefPubMedGoogle Scholar
  • 5 Yang T, Huang Y, Li J. et al. Neonatal gastric perforation: case series and literature review. World J Surg 2018; 42 (08) 2668-2673
    CrossrefPubMedGoogle Scholar
  • 6 Iacusso C, Boscarelli A, Fusaro F, Bagolan P, Morini F. Pathogenetic and prognostic factors for neonatal gastric perforation: personal experience and systematic review of the literature. Front Pediatr 2018; 6: 61
    CrossrefPubMedGoogle Scholar
  • 7 Duran R, Inan M, Vatansever U, Aladağ N, Acunaş B. Etiology of neonatal gastric perforations: review of 10 years' experience. Pediatr Int 2007; 49 (05) 626-630
    CrossrefPubMedGoogle Scholar
  • 8 Kasdallah N, Ben Salem H, Kbaier H, Blibech S, Douagi M. Congenital diaphragmatic eventration complicated with neonatal gastric perforation. Tunis Med 2017; 95 (02) 136-138
    PubMedGoogle Scholar
  • 9 Antabak A, Bogović M, Vuković J. et al. Postoperative gastric perforation in a newborn with duodenal atresia. J Neonatal Surg 2016; 5 (04) 62
    CrossrefPubMedGoogle Scholar
  • 10 Khan YA, Zamir N. Missed congenital pyloric atresia with gastric perforation in a neonate. J Neonatal Surg 2012; 1 (02) 32
    PubMedGoogle Scholar
  • 11 Rosser SB, Clark CH, Elechi EN. Spontaneous neonatal gastric perforation. J Pediatr Surg 1982; 17 (04) 390-394
    CrossrefPubMedGoogle Scholar
  • 12 Kara CS, Ilçe Z, Celayir S, Sarimurat N, Erdogan E, Yeker D. Neonatal gastric perforation: review of 23 years' experience. Surg Today 2004; 34 (03) 243-245
    CrossrefPubMedGoogle Scholar
  • 13 Babayigit A, Ozaydın S, Cetinkaya M, Sander S. Neonatal gastric perforations in very low birth weight infants: a single center experience and review of the literature. Pediatr Surg Int 2018; 34 (01) 79-84
    CrossrefPubMedGoogle Scholar
  • 14 Oztürk H, Onen A, Otçu S, Dokucu AI, Gedik S. Gastric perforation in neonates: analysis of five cases. Acta Gastroenterol Belg 2003; 66 (04) 271-273
    PubMedGoogle Scholar
  • 15 Lin CM, Lee HC, Kao HA. et al. Neonatal gastric perforation: report of 15 cases and review of the literature. Pediatr Neonatol 2008; 49 (03) 65-70
    CrossrefPubMedGoogle Scholar
  • 16 Woo J, Eusterbrock T, Kim S. Intrauterine gastric perforation. Pediatr Surg Int 2006; 22 (10) 829-831
    CrossrefPubMedGoogle Scholar
  • 17 Garge SS, Paliwal G. Neonatal gastric perforation: our experience and important preoperative and intraoperative caveats to prognosticate and improve survival. J Indian Assoc Pediatr Surg 2020; 25 (04) 201-205
    CrossrefPubMedGoogle Scholar
  • 18 Byun J, Kim HY, Noh SY. et al. Neonatal gastric perforation: a single center experience. World J Gastrointest Surg 2014; 6 (08) 151-155
    CrossrefPubMedGoogle Scholar
  • 19 Chen TY, Liu HK, Yang MC. et al. Neonatal gastric perforation: a report of two cases and a systematic review. Medicine (Baltimore) 2018; 97 (17) e0369
    CrossrefPubMedGoogle Scholar
  • 20 Ohshiro K, Yamataka A, Kobayashi H. et al. Idiopathic gastric perforation in neonates and abnormal distribution of intestinal pacemaker cells. J Pediatr Surg 2000; 35 (05) 673-676
    CrossrefPubMedGoogle Scholar
  • 21 Jactel SN, Abramowsky CR, Schniederjan M. et al. Noniatrogenic neonatal gastric perforation: the role of interstitial cells of Cajal. Fetal Pediatr Pathol 2013; 32 (06) 422-428
    CrossrefPubMedGoogle Scholar
  • 22 Joshi M, Krishnan L, Kuruvila S. Large gastric perforation in carmi syndrome: a morbid complication in a rare association. J Neonatal Surg 2012; 1 (04) 57
    CrossrefPubMedGoogle Scholar
  • 23 Mathew A, Wanshnong L, Longtrai S, Ghosh D. Bananas and neonatal gastric perforation. J Indian Assoc Pediatr Surg 2012; 17 (02) 88-89
    CrossrefPubMedGoogle Scholar
  • 24 Bos ME, Wijnen RM, de Blaauw I. Gastric pneumatosis and rupture caused by lactobezoar. Pediatr Int 2013; 55 (06) 757-760
    CrossrefPubMedGoogle Scholar
  • 25 Hall NJ, Ward HC. Lactobezoar with perforation in a premature infant. Biol Neonate 2005; 88 (04) 328-330
    CrossrefPubMedGoogle Scholar
  • 26 Mathur NB, Gupta A. Neonatal zygomycosis with gastric perforation. Indian Pediatr 2013; 50 (07) 699-701
    CrossrefPubMedGoogle Scholar
  • 27 Ebenezer K, Bose A, Carl S. Neonatal gastric perforation following inadvertent connection of oxygen to the nasogastric feeding tube. Arch Dis Child Fetal Neonatal Ed 2007; 92 (05) F407
    CrossrefPubMedGoogle Scholar
  • 28 Milassin TG, Ng ZQ, Gera P. Haematemesis as a sign of silent neonatal gastric perforation. J Paediatr Child Health 2020; 56 (11) 1830-1832
    CrossrefPubMedGoogle Scholar
  • 29 Khan YA, Akhtar J. Pneumoscrotum: a rare presentation of gastric perforation in a neonate. APSP J Case Rep 2010; 1 (02) 15
    PubMedGoogle Scholar
  • 30 Theodorou CM, Chen P, Vanover MA. et al. Total gastrectomy with delayed Hunt-Lawrence pouch reconstruction for neonatal gastric perforation presenting with hematemesis. J Pediatr Surg Case Rep 2020; 63: 101686
    CrossrefPubMedGoogle Scholar
  • 31 Jawad AJ, Al-Rabie A, Hadi A. et al. Spontaneous neonatal gastric perforation. Pediatr Surg Int 2002; 18 (5-6): 396-399
    CrossrefPubMedGoogle Scholar
  • 32 Durham MM, Ricketts RR. Neonatal gastric perforation and necrosis with Hunt-Lawrence pouch reconstruction. J Pediatr Surg 1999; 34 (04) 649-651
    CrossrefPubMedGoogle Scholar
  • 33 Govind SK, Livingston M, Flageole H, Van Houwelingen L. Gastric necrosis in a term infant treated with near-total gastrectomy and delayed reconstruction with a Hunt-Lawrence pouch. BMJ Case Rep 2019; 12 (12) e231869
    CrossrefPubMedGoogle Scholar