Neonatal Gastric Necrosis and Perforation Treated by Subtotal Gastrectomy and Esogastric Anastomosis: A Case Report

Abstract

Patient: Male, 4-day-old Final Diagnosis: Gastric perforation and necrosis Symptoms: Acute abdominal distension • metabolic acidosis • respiratory distress Medication: — Clinical Procedure: — Specialty: Pediatrics and Neonatology • Surgery Objective: Congenital defects/diseases Background: Gastric necrosis and perforation are rare life-threatening conditions in preterm neonates, which require urgent diagnosis and surgical intervention. Case Report: We report a case of a 4-day-old patient with neonatal gastric necrosis. The patient presented with sudden acute abdominal distension, respiratory distress, and metabolic acidosis. The abdomen was markedly distended, tender, and tympanic with collateral circulation. An X-ray of the abdomen showed a huge pneumoperitoneum. An urgent exploratory laparotomy revealed 2 wide horizontal perforations and necrosis of the fundus and gastric body. Subtotal gastrectomy with esogastric anastomosis was done. Postoperatively, the patient was administered total parenteral nutrition and triple antibiotics and improved gradually. He passed stool and the abdomen was soft, lax, and non-distended and the wound healed. An upper gastrointestinal tract (UGIT) contrast study 1 week after the operation showed no leakage or stricture. The patient was discharged 2 months postoperatively with a bodyweight of 2 kg and was followed in the Outpatient Department (OPD). The patient survived after 80% gastric resection for necrosis of the stomach, which was a unique outcome for this major surgery. Conclusions: Gastric perforation is a rare life-threatening condition in preterm neonates, usually managed by direct closure in layers. Exceptionally, partial gastrectomy is needed, which is a major operation, with a high mortality rate and poor outcome. We present a case of a preterm neonate who survived after 80% gastric resection for stomach necrosis.

Sleeve gastrectomy for multiple gastric perforations in a preterm: A case report

“…18 Rarely, partial gastrectomy or subtotal gastrectomy is indicated. 17,19 The major indication of sleeve gastrectomy is for bariatric interventions. 20 However, sleeve gastrectomy has also been tried as a therapeutic option for multiple gastric perforations in neonates when there is adequate vasculature in the lesser curvature.…”

“…Rarely, partial gastrectomy or subtotal gastrectomy is indicated 17,19 . The major indication of sleeve gastrectomy is for bariatric interventions 20 .…”

Differences in neonatal gastric tubes during insertion into a 3D model in relation to risk of potential perforation

“…This is in congruence with the observations describing higher rates of gastric perforations at the greater curvature of the stomach. 6,11,[16][17][18] Sinnathamby et al described an infant with gastric tube pushing against the greater curvature of the stomach leading to gastric perforation. 19 In clinical practice, the behavior of the latter mentioned gastric tube may cause lacerations and bulging of the wall in very immature preterm infants.…”

The Subdiaphragmatic Angle Of The Gastric Tube In Neonates – A Potential Predictor For Perforations?

“…The ESPED study was approved by the Ethics Committee of the University of Duisburg-Essen (17-7491-BO) and is part of various studies to describe rare diseases in German infants. Additional cases were included based on information of published literature, getting in contact with the authors [5,[7][8][9][10][11][12][13][14][15].…”