Spontaneous gastric perforation: is it really common?

Abstract

Background Neonatal gastric perforation (NGP) is a rare, serious, and life-threatening condition which needs early recognition with prompt intervention for better prognosis. Its etiology is not yet well established, but multiple speculations have been put forth for its etiopathogenesis. Few most considered are traumatic, spontaneous, or secondary to inflammatory process like necrotizing enterocolitis. This study describes the etiological and prognostic factors for patients with NGP in our experience at a single center. Results A total of 46 neonates were included. Male gender predominated with M:F being 1.7:1. Most (n=36) neonates presented within 10 days of life whereas 8 neonates presented within 15 days. At presentation, gas under diaphragm was the most common radiologic finding in 25 (54.3%) neonates. On exploratory laparotomy, it was found that greater curvature was involved in maximum number of cases (n=27), followed by lesser curvature and anterior and posterior walls of the stomach. Most of perforations were within 1–5 cm in size. Gastrorrhaphy was done in all cases, and in two cases, feeding jejunostomy was done along with repair for feeding purpose. Finally, spontaneous NGP was diagnosed in 30 (60.8%), and NEC patches on other parts of the intestine were seen in 11 patients. Postoperatively, 28 neonates developed complications in the form of sepsis (n=13), wound infection (n=10), and burst abdomen (n=5). Regarding clinical outcome, 27 (58.7%) were discharged from the hospital whereas 19 (39.3%) patients died. Conclusion Our results show that spontaneous NGP is most commonly associated with NEC in our population, usually affecting the greater curvature. We observed a high mortality rate; however, good ICU care may improve the survival.

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

“…Most gastric perforations are located at the greater curvature of the stomach. 6,11,[16][17][18] This agrees with the observation in this study that the angle of the esophagogastric junction influences the further course of the tube during insertion, which often resulted in contact with the greater curvature of the stomach. In all three gastric tubes, a substantial part of insertions (65 of 99 inserts; line 3 of Table 1) ended with the tube tip at the stomach wall and the positioning of the tip typically occurred at the greater curvature, as depicted in Table 1 (64 out of 65 insertions).…”

“…Further risk factors, like medication (e.g., postnatal steroid therapy, ibuprofen or indomethacin treatment of a hemodynamically significant patent ductus arteriosus) or inflammatory processes (e.g., necrotizing enterocolitis) might also influence the manifestation of gastric perforations. 6,[9][10][11] Although the insertion of a gastric tube is often performed during neonatal care, little is known about local traumatic lacerations as these are only visible during endoscopy. Figure 1A illustrates such an example of a mechanical injury by a gastric tube in an infant after surgery due to omphalocele.…”

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

“…The timely diagnosis of perforations of the esophagogastric junction or the stomach caused by gastric tubes in neonates is essential to reduce mortality, since its detection prior to the development of massive pneumoperitoneum and severe peritonitis enables prompt conservative management consisting of removal of the dislocated feeding tube, initiation of parenteral nutrition, and administration of broad-spectrum antibiotic therapy [3,8,16].…”

“…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].…”

“…Several reports on neonatal gastric perforation in combination with necrotizing enterocolitis and its sequelae have been published [8,16]. In these cases, the etiology of the former often remains unclear.…”