Neonatal Gastric Perforation due to Barotrauma

Abstract

Gastric perforations in newborns are rare, but serous surgical emergency. Neonatal gastric perforation (NGP) was first described back in early 19th century. Since then the reported numbers has kept increasing, but the mortality has been reducing due to improvement in the neonatal intensive care. The increase in number may be due to the survival of low birth weight and premature newborns. The incidence of NGP is 1 in 5000 live births, accounting for 7% of all neonatal gastrointestinal perforations [1]. Nearly 47% of NGP were considered idiopathic while rest were mainly due to mechanical ventilation, feeding tubes, necrotizing enterocolitis, duodenal/jejunal obstruction, antenatal drugs (aspirin) and oesophageal atresia/trachea oesophageal fistula [2,3]. The symptoms are sudden deterioration of the clinical condition with difficulty breathing and abdominal distension. A simple X-ray of the abdomen is the first line investigation to visualize the pneumoperitoneum. Complete blood count, C - reactive protein, and arterial blood gas will also support investigations in diagnosing the risk factors and future management. The main treatment is ventilatory support and prompt surgical repair of the perforation. This case report is of a case of NGP in a preterm newborn with a single perforation in the greater curvature of the stomach, which was successfully treated with surgery.