Gastric Perforation in Newborns: Analysis of 14 Cases

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.