J Korean Assoc Pediatr Surg.  2017 Dec;23(2):37-41. 10.13029/jkaps.2017.23.2.37.

Clinical Review of Spontaneous Neonatal Gastric Perforation

Affiliations
  • 1Department of Surgery, University of Ulsan College of Medicine and Department of Pediatric Surgery, Asan Medical Center Children's Hospital, Seoul, Korea. sckim@amc.seoul.kr

Abstract

PURPOSE
Spontaneous neonatal gastric perforation is a rare but fatal disease with unclear etiology. In this study, we reviewed its clinical manifestations, outcomes, and discussed the etiology and prognostic factors.
METHODS
There were 12 neonates with gastric perforation in our hospital from 1989 to 2015. Their medical records were reviewed retrospectively including birth record, associated disease, site and size of perforation, type of surgical management, clinical outcome. Also, the prognostic factors were analyzed.
RESULTS
The median gestational age and birth weight was 32 weeks (range, 26-43 weeks; preterm birth rate, 66.7%) and 1,883 g (range, 470-4,400 g), respectively. Five patients had associated gastrointestinal anomalies including esophageal atresia and tracheoesophageal fistula (two patients), midgut volvulus, non-rotation and microcolon, and meconium plug syndrome. The median age at surgery was six days after birth (range, 2-13 days), and the median weight at surgery was 1,620 g (range, 510-3,240 g). Upper third part of stomach was the most frequently involved location of perforation. The size of perforation varied from pin point to involving the whole greater curvature. Primary repairs were done in seven cases, and in five cases, resections of necrotic portion were needed. Mortality rate was 33.3% (n=4), morbidity (re-operation) rate was 16.7% (n=2). The causes of death were sepsis (n=3), and heart failure from Ebstein anomaly (n=1). The median hospital stay was 92.5 days (range, 1-176 days). The factors mentioned as prognostic factors in previous studies showed no significant relations to the mortality and morbidity in our study.
CONCLUSION
There were improvements of outcomes in patients with large size perforation. As previous studies, we assume these improvements were possible due to the improvements of critical care medicine. Given that rare incidence, a multi-center study can help us get a better understanding of this disease, and a better outcome.

Keyword

Neonate; Gastric perforation

MeSH Terms

Birth Certificates
Birth Weight
Cause of Death
Critical Care
Ebstein Anomaly
Esophageal Atresia
Gestational Age
Heart Failure
Humans
Incidence
Infant, Newborn
Intestinal Volvulus
Length of Stay
Meconium
Medical Records
Mortality
Parturition
Premature Birth
Retrospective Studies
Sepsis
Stomach
Tracheoesophageal Fistula
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