Gastric necrosis in newborns: a report of 11 cases

Abstract

Eleven neonates ranging in gestational age from 34 to 40 weeks presented with gastric necrosis. The 4 full-term neonates showed sudden-onset hemorrage and "coffee-ground" vomiting; in the 7 premature babies the initial clinical finding was abdominal distention. The criteria for diagnosis were: perinatal distress in prematures and transient neonatal respiratory distress in full-term babies. Radiographic evidence of gastric distention was typical and preceded clinical signs of hematemesis and gastric perforation. Surgery was performed in 8 patients; 3 received medical treatment. At surgery 1 total and 3 subtotal gastrectomies and 4 segmental gastric resections were performed. Three of these patients died post-operatively as a consequence of multiorgan failure; a second look was necessary in one patient 1 week after surgery because of prepyloric perforation due to ulcers. Biopsy specimens taken from the site of perforation demonstrated extensive necrosis; ulceration was disseminated in the surrounding gastric mucosa; no signs of phlogosis were detected. The diagnosis, treatment, and physiopathologic considerations are reviewed.

Neonatal necrotizing gastritis; hypoplastic left heart

“…3,4 Gastric pneumatosis can be separated into gastric emphysema and necrotizing gastritis or emphysematous gastritis. 5 Gastric emphysema is usually due to a relatively benign etiology, often associated with elevated gastric pressures.…”

“…Distention alone is a more common finding in premature infants, whereas full-term infants more often present with hemorrhage and vomiting. 4 The risk of NEC is substantial in patients with hypoplastic left heart. Among patients with congenital heart disease who developed NEC, slightly more than half (11/21 patients) had hypoplastic left heart or critical aortic stenosis.…”

Peptic ulcer disease in children

“…55 Thus, for the most part, neonatal gastropathies are simply stress lesions in this age group, but with a greater predilection to haemorrhage and perforation. 56 However, haemorrhagic gastropathy has also been reported in otherwise healthy full-term infants 57 , presenting with severe upper gastrointestinal tract haemorrhage, and in one case as antenatal haemorrhage. 58 …”

Neonatal gastric perforation

“…The incidence is higher in males and predominantly affects premature infants (1)(2)(3)(4)(5) and usually presents within the first seven days (2). S u r g i c a l repair of gastric perforation may be challenging as the whole, or large areas, of the stomach are usually involved by the pathology responsible for the perforation necessitating total, subtotal or segmental gastrectomy (2).…”

“…Neonatal gastric perforation is a surgical emergency associated with high mortality(1) accounting for 10-16% of all neonatal gastro-intestinal tract (GIT) perforations (2). The incidence is higher in males and predominantly affects premature infants (1)(2)(3)(4)(5) and usually presents within the first seven days (2).…”