Spontaneous Rupture of the Stomach in the Newborn: Clinical and Experimental Evaluation

Abstract

Extractwhen the infants were taking formula orally, the gastrostomy tubes were vented to a large coll~cting balloon aboveeach patient (15). o u r study presents an experimental model for studying gastric ~h~ air swallowed into the stomach was readily measured with this rupture in the newborn. w e showed that gastric rupture could be system (Fig. I ). Because spontaneous rupture usually occurs when produced in eight newborn rodents and in three puppies less than 10 an infant is supine (6), these infants were fed in this position, which days old after injection of 120 ml air at 100 mm Hg pressure in the also prevented eructation. Initially, the infants were fed standard rodents and ml air at 240 inin Hg pressure in the puppies. formula, but after two gastrostomy tubes partially obstructed, Gastric rupture occurred with animals supine and with approxi-they were fed with sugar water only. Larger volumes of air were mately 20 ml barium injected into the stomach. Positioning of the collected from this latter group.animal in the supine position permitted the barium to pool in the To explore Hood's theory (6). that the antrum acts as a "fluid antral-pyloric region of the stomach.trap." the following experiment was performed. After intramuscular anesthesia. a thin nasogastric tube was placed in either rats', Speculation guinea pigs', or puppies' stomachs under fluoroscopic control.we believe that spontaneous gastric rupture occurs as a result o f a With the animal supine, either standard infant formula or an pooling of liquid barium or food in the pylorus equivalent volume of thin (25%) barium sulfate suspension (appermits a physio~ogic outlet obstruction of the stomach. our proximately 20 ml in each instance) was instilled into the stomach.observations indicate that normal infants accumulate considerable The animal was positioned SO that the liquid ~o o l e d in the amounts of air in the stomach while feeding. the stomach antral-pyloric region (as checked fluoroscopically in the animals distends reflux of air into the esophagus is impeded by an air-fluid given the barium suspension). A "Y" connector was placed in the trap at the esophageal-gastric junction. Thus, our study suggests proximal end of the nasogastric tube. o n e end of the Y connector that increased intraluminal pressure the stomach is sufficient Was joined with a 50-cc syringe. permitting increments of air to be to cause gastric rupture in the newborn and that the fluidmair trap is introduced; the other end was connected to a gauge that measured an important mechaism in gastric rupture. pressure after each injection (Fig. 2). Eight rodents (five rats and three guinea pigs) and six puppies were used for this study. After this procedure the animals were Spontaneous rupture of the stomach characteristically occurs in autopsied and the stomachs examined. the first days of life as a linear tear high on the stomach wall. Since the original description by Siebold in 1825. there has been a great RESULTS

Spontaneous gastric perforation: is it really common?

“…This finding was compared with Kara et al and Byun et al [6,12] Leone and Krasna reported that 4 out of 7 neonates had pre-existing cause while 3 had no identifiable cause of NGP [7]. In literature, the etiology of NGP is still debatable though many suggested causes like congenital weakness or absence of muscle [13], high gastric acidity leading to ulceration [14], trauma to gastric wall [15], neonatal asphyxia causing intestinal ischemia [16], raised intragastric pressure caused by swallowing of air or distal obstruction [17,18], and lack of intestinal pacemaker cells [19] or C-KIT + mast cells [20]. Usually, the mixture of causes is proposed as far as etiology of NGP is concerned [21], and the most common cause was found to be the raised intragastric pressure causing rupture of the stomach wall usually in a dilated stomach and uncoordinated vomiting due to poor neurologic control [8,18].…”