Gastric perforation in an extremely low birth weight infant recovered with percutaneous peritoneal drainage

Department of Neonatology, Dr. Sami Ulus Maternity and Children's Hospital, Ankara, Turkey.
The Turkish journal of pediatrics (Impact Factor: 0.43). 07/2011; 53(4):467-70.
Source: PubMed


Neonatal gastric perforation is an uncommon but life-threatening condition, which is mainly encountered in premature infants. Primary surgical repair is the principal mode of the treatment. Gastric perforation in neonates improving with percutaneous peritoneal drainage alone has not been described previously. Therefore, an extremely low birth weight infant is presented herein in order to emphasize that gastric perforation may improve with percutaneous peritoneal drainage alone. Isolated gastric perforations in newborn infants may be improved with percutaneous peritoneal drainage alone without need for primary surgical repair.

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Available from: Mustafa Aydin
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    • "Neonatal stress consequent to preterm birth is a determining factor in the etiopathogenesis. Preterm birth and a low birth weight predispose infants to gastric perforation [16]. The most common cause of gastrointestinal perforation in preterm infants is NEC. "
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    ABSTRACT: Neonatal gastric perforation is a rare and serious issue. This study aimed to highlight the vital clinical features and identify prognostic factors in such cases. Medical charts from January 1997 through December 2008 were reviewed retrospectively. Neonates with a diagnosis of gastric perforation were included. Thirteen patients were identified with a male:female ratio of 9:4. Five (38%) were preterm infants. The mortality rate was 30% (4/13), and the median age of onset was 3days (range: 1-14days). The most common presenting sign was abdominal distension, followed by respiratory distress and vomiting. Except for one patient in whom gastric perforation was diagnosed during surgical repair for gastroschisis, all patients had pneumoperitoneum on admission; 70% and 46% of patients had peritonitis and sepsis, respectively. Concomitant gastrointestinal (GI) tract anomalies or disorders included ischemic bowel/necrotizing enterocolitis (5 patients), intestinal malrotation (2), duodenal web (1), hiatal hernia (1), and gastroschisis (1), which necessitated secondary operations during hospitalization in 5 patients. Seven patients had leukopenia on admission, and 9 developed thrombocytopenia in the following 48h. All patients who died presented with leukopenia on admission and thrombocytopenia in the following 48h, yielding sensitivity and specificity rates of 100% and 67%, respectively. Neonatal gastric perforation is often concomitant with GI anomalies or inflammatory/infectious disease. Patients who were outborn and those with leucopenia, peritonitis, and thrombocytopenia development within 48h were at risk for poor outcome. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · Apr 2015 · Journal of Pediatric Surgery
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    • "During the follow-up, the complete resolution of the free air with presence of gastric gas shadow was observed. Without requirement for primary surgical repair, percutaneous drainage was terminated on the 27 th postnatal day (Aydin et al., 2011). "
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    ABSTRACT: Objectives: We aimed to present our experience on the gastrointestinal (GI) perforations and the factors affecting the outcome. Design: Retrospective study Setting: A tertiary neonatal intensive care unit Subject and Methods: A total of 38 neonates with GI perforation managed in our neonatal intensive care unit during 2005 to 2011 were included into the study. Interventions: The patients were grouped as necrotizing enterocolitis (NEC) and non-NEC patients. Results: Twenty four of 38 infants (63.2%) were premature. Non-NEC conditions were most common cause of the perforation (57.9%). Twelve cases were managed with peritoneal drainage alone. Surgical repair without conservative approach was performed in 19 patients, while seven of the patients underwent to surgical intervention after decompression by the percutaneous drainage. The overall mortality rate was 28.9%. It were 43.7% and 18.1% in NEC and non-NEC group, respectively (p>0.05). The mortality rate in small bowel perforation and colorectal perforation was 30.7% and 22.2%, respectively (p>0.05). All patients with gastric perforation survived. Conclusions: Non-NEC conditions were common cause of GI perforations. Although some patients could be managed with conservative approach, surgical exploration is still the main management model. The prognosis of the gastric perforation was good; however, the prognosis of small bowel and colorectal perforation was poor.
    Full-text · Article · Oct 2013
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    ABSTRACT: Objective: Neonatal gastric perforation is a rare entity with poor prognosis. Etiology of this anomaly is unknown but prematurity, low birth weight and hypoxia is considered as contributing factors. The purpose of this study is to share our experience regarding the etiology, clinical features and surgical outcome of neonatal gastric perforation. Methodology: We reviewed the data of all newborn with gastric perforation in Liaquat University Hospital as well as in private practice, from July 2003 to June 2010 with respect to age, sex, weight, parity, mode of delivery, clinical presentations, investigations, associated anomalies and surgical outcome. Results: There were 14 patients, 9 males and 5 females. Birth weight ranged from 1.6 kg to 3 kg with mean of 2.3 kg. Out of 14 babies 11(87.57%) were full term and 3(21.42%) preterm. Clinical features observed were abdominal distension, respiratory distress, vomiting and hematemesis. Associated anomalies were found in three patients, which were Down's syndrome, talipes equinovarus and bilateral inguinal herniae with hypospadias. Most of the patients had spontaneous gastric perforation and few might had ischemic cause. Nine had perforation on posterior wall of body of stomach and three on posterior wall of greater curvature of stomach while two had on anterior wall of body of stomach and anterior wall of greater curvature of stomach respectively. All the patients had primary closure of perforation along withintraperitoneal placement of drain. Complications observed in 4 (28.57%) cases, three term low birth weight and one preterm baby; wound dehiscence in two patients, who were re-operated, wound infection in one and pneumonia in one which were treated conservatively. Three patients 21.4% (two term low birth weight and one preterm) expired in this series due to septicemia. Conclusion: Prominent features in this study were low birth weight and perforation on the posterior surface of stomach. There is need to evaluate the correlation of these findings.
    Preview · Article · Sep 2011 · Journal of the Liaquat University of Medical and Health Sciences
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