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Objective:To study the clinical characteristics of neonatal gastric perforation (NGP) and risk factors of mortality.Methods:From January 2015 to May 2022, infants with NGP admitted to NICU of our hospital were retrospectively studied. They were assigned into the survival group and the death group. Clinical manifestations, laboratory and imaging results, surgical treatments and prognosis were compared and risk factors of mortality were determined.Results:A total of 27 infants with NGP were enrolled, including 17 males and 10 females. 24 were premature infants and 3 were term infants. 26 infants had low birth weight. 3 infants had neonatal resuscitation due to asphyxia, 10 received positive pressure ventilation before the onset of perforation symptoms, 2 showed gastrointestinal malformations and 3 with septic shock before surgery. The median age of onset was 2.0 d. The main presenting symptom was abdominal distension, with most perforations occurring at the greater curvature of the stomach. 20 cases had congenital gastric muscular layer defects. 21 cases survived and 6 cases died. Age of onset was later in the death group than the survival group [2.5 (2.0, 7.8) days vs. 1.9 (1.4, 3.0) days]. The survival group had higher preoperative platelet count than the death group [(218±80) ×10 9/L vs. (126±73)×10 9/L]. The incidences of thrombocytopenia, septic shock and multi-organ dysfunction syndrome before surgery in the survival group were significantly lower than the death group ( P<0.05). Logistic regression analysis showed that preoperative thrombocytopenia was a risk factor for NGP mortality ( OR=19.000, 95% CI 2.029-177.932, P=0.010). Conclusions:NGP is more common in male infants, premature infants and low birth weight infants. The most common etiology is congenital gastric muscular layer defects. The mortality rate is high and preoperative thrombocytopenia is a risk factor for mortality.
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Objective:To investigate the clinical characteristics of congenital esophageal atresia with gastric perforation, and to improve pediatricians′ understanding of this disease.Methods:The clinical data of five neonates with congenital esophageal atresia and gastric perforation treated in the neonatal intensive care unit of the Affiliated Hospital of Qingdao University from 2012 to 2022 were analyzed retrospectively.Results:Among the five neonates, four were boys and one was girl.The gestational age was 28 + 5 to 37 + 6 weeks, the birth weight was 1 100~2 350 g. All of them had dyspnea and feeding difficulties after birth.Gastric perforation occurred in three cases during invasive mechanical ventilation, one case during non-invasive ventilation, and one case during nasal catheter oxygen inhalation.Emergency primary gastric repair was performed, followed by secondary esophageal anastomosis.All the patients were cured and discharged from hospital. Conclusion:Gastric perforation is a rare complication of congenital esophageal atresia, which is more common in premature infants and low birth weight infants.Mechanical ventilation may promote the occurrence of gastric perforation.If gastric perforation is complicated, repair should be performed as soon as possible, and esophageal anastomosis surgery should be performed early after stability to improve the final outcome.
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Mucormycosis is a rare infection which is largely diagnosed in immune-compromised patients. The infection can cause pulmonary, rhinocerebral, skin and soft tissue, central nervous system, gastrointestinal and disseminated disease, with gastrointestinal involvement being the rarest presentation. Outcome and mortality of zygomycosis varies with the underlying condition and site of infection, it is however very high in general. Diagnosis is usually delayed and delay in initiation of amphotericin B treatment leads to poor outcome. We report rare case of a malnourished young adult who presented with gastric perforation peritonitis due to mucormycosis infection.
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Objective@#To evaluate the feasibility and short-term efficacy of a novel and simplified closure method developed by our team for the defect closure after endoscopic full-thickness resection (EFTR) for gastric submucosal tumors (SMT) in the gastric wall.@*Methods@#A prospective single-arm clinical study was used. Inclusion criteria: (1) the lesion was located in the fundus or the greater curvature of the stomach, and was confirmed to originate from the muscularis propria layer; (2) the diameter of the tumor was ≤3.5 cm, and the tumor had no extensive adhesion to the peritoneal tissues and organs in extraperitoneal cavity; (3) the tumor had no malignant features under ultrasound endoscopy; (4) the patient agreed to participate in the study; (5) patients with severe complications were excluded. Based on the above criteria, 20 patients with gastric SMT at the Endoscopy Center of Zhongshan Hospital of Fudan University from January 2015 to March 2018 were enrolled in this study, including 5 males and 15 females with mean age of 61.1 (38 to 70) years. Grasping forceps-assisted endo-loop snare ligation device which is called "Shao-Mai" method was used to close the defect site. All the patients underwent EFTR and "Shao-Mai" method to perform defect closure. After successful tumor resection by EFTR, an endo-loop was anchored onto the edge of the gastric defect with grasping forceps assistance and closed tightly. The observation indicators included tumor size, en bloc resection, operation time, postoperative complications and hospital stay. The follow-up indicators included tumor residual, local recurrence, and metachronous lesions.@*Results@#All the 20 lesions were located in the muscularis propria with a size of 0.5-3.5 (mean 1.4) cm. Three of them were located in the greater curvature of the mid-upper gastric body, 17 were located in the fundus. The endoscopic "Shao-Mai" closure was successfully performed after EFTR in all the 20 cases. Endoscope was used uniquely through the entire process, without laparoscopic assistance. The operative time was 20-100 (mean 43.8) minutes, while the "Shao-Mai" closure procedure took a range of 3-30 (mean 10.1) minutes. The en bloc resection rate was 100%. The pathological diagnosis included 17 gastrointestinal stromal tumors and 3 leiomyomas. No major complications occurred during or after surgery. All the patients were discharged 1-11 (mean 3.1) days after operation. The wounds of all the cases were healed completely six months after operation and only scar was observed without ulcer. No residual lesion, tumor recurrence or metastasis, leakage or fistula of digestive tract were found during the follow-up period of 15-54 (median 41) months.@*Conclusion@#The endoscopic "Shao-Mai" closure method is a simplified novel way, which is feasible, effective, and safe for closing the gastric defect after EFTR.
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Evisceration of abdominal viscus following 'Flowerpot firecracker' (tubri) blast injury to the abdomen is a rare but dangerous form of domestic accident. Lack of knowledge and non-compliance of safety measures is the major reason for firecracker eventualities. A 10-year male child presented three hours post-injury with a wound over the upper abdomen. On examination there was evisceration of part of stomach along with colon through supraumbilical abdominal wound. Resuscitation and repair following exploratory laparotomy performed. Patient recovered well postoperatively. Public awareness and safety measures need to be taken to prevent the fatal outcomes of firecracker misuse.
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Background: Authors hypothesized the qSOFA score would be useful in sepsis patients caused by gastric perforation. The present study investigated the relationship of qSOFA value to outcome of patients with gastric perforation in Samarinda.Methods: This research was analytical, descriptive research method using cross-sectional study design 70 patients. Data analysis was obtained to see the relationship between age, gender, vital sign qSOFA and survival in gastric perforation patients.Results: Mean systolic blood pressure was significantly higher in subjects who lived than those who died, i.e. 105.5 vs 92.5 (p <0.001). Mean diastolic blood pressure was significantly higher in subjects who lived than those who died, ie 80.0 vs 66.8 (p <0.001). The respiration rate was significantly lower in subjects who lived than those who died, namely 22.9 vs 24.6 (p <0.001). The mean GCS score was significantly higher in subjects who lived than those who died, ie 14.2 vs 12.2 (p <0.001).Conclusions: The higher the qSOFA score in the study subjects with gastric perforation, the higher the mortality rate. There was a relationship between the qSOFA value and the outcome of patients with gastric perforation where the mean qSOFA score was significantly lower in subjects who lived than those who died.
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The goals of this study were, first, to evaluate the feasibility of inducing gastric perforation with 99% alcohol injection after electrocautery (EA-method), and, second, to observe “enhanced peritoneal stripe sign (EPSS)” and other lesions upon induction of gastric perforation. Six clinically normal beagle dogs were prepared for gastric perforation using endoscopy. After gastric perforation, EPSS and other lesions on ultrasonography were observed eventually (at 0 h, 3 h, day 1, day 2, day 3, day 4, day 5, and day 6). We graded the EPSS depending on its width and number. EPSS was observed until day 4 of the examination in all the 6 dogs. The grades of EPSS were the highest at 3 h and declined gradually. Peritoneal effusion was observed in all dogs at 3 h and on day 1. Regional bright mesenteric fat was confirmed in all dogs on days 3 and 4. In conclusion, gastric perforation can be induced by EA-method. EPSS and peritoneal effusion appear at a very early stage, and regional bright mesenteric fat was identified on days 3 and 4 in almost all dogs with gastric perforation.
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Animals , Dogs , Ascitic Fluid , Electrocoagulation , Endoscopy , Pneumoperitoneum , UltrasonographyABSTRACT
The ingestion of corrosive substances often leads to severe morbidity and mortality. Acids produce coagulation necrosis with a lesser degree of penetration, whereas alkalis produce liquefactive necrosis with penetration. Acetic acid is a clear, colorless organic acid with a pungent, vinegar-like odor. The ingestion of highly concentrated acetic acid (glacial acetic acid) may cause a range of complications. On the other hand, perforation of the stomach is extremely rare but it has a high mortality rate. This paper reports a case of perforation of the stomach after the ingestion of glacial acetic acid with suicidal intent in an otherwise healthy 76-year-old woman.
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Aged , Female , Humans , Acetic Acid , Alkalies , Eating , Hand , Mortality , Necrosis , Odorants , StomachABSTRACT
Objective To evaluate the feasibility and efficacy of twin grasper combined with endoloops on closing acute stomach perforation.Methods Two experimental porcines of stomach perforation underwent endoscopic closure by twin grasper combined with endoloops.Survival conditions and closure of perforating were observed.Results Mild infection and abdominal adhesions were observed in one week after operation.The nylon rope fell off and an ulcer-like lesion was presented in the closed position.The methylene blue leak test was negative.Histologic examination revealed chronic inflammatory cells infiltration,granulation,fibroplasias,and regenerative mucous membrane crawling toward the center of perforation.Conclusion The technique of twin grasper combined with nylon ropes in closing the acute stomach perforation is feasible and effective.
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The authors describe a fatal case of gastric perforation secondary to an ulcerated metastasis in a woman with undiagnosed breast cancer. The 48-year-old woman, with no significant medical history, presented with weight loss, persistent dyspepsia and pain in the epigastric and mesogastric region. She was treated by her primary care physician with proton-pump inhibitors and antispasmodics. The following day she was found dead at her home. External examination showed a tumefaction in the lateral region of her left breast, near the axilla. Autopsy revealed 1000 ml of turbid, light-brown peritoneal fluid in the abdominal cavity and a perforated gastric wall. Histological examination of the breast mass showed an infiltrating, poorly-differentiated breast carcinoma. Microscopical analysis of the stomach wall revealed a perforated metastatic gastric ulcer. Immunohistochemistry was required to confirm the neoplastic involvement of the stomach due to metastatic breast cancer.
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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.
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Humans , Infant, Newborn , Birth Certificates , Birth Weight , Cause of Death , Critical Care , Ebstein Anomaly , Esophageal Atresia , Gestational Age , Heart Failure , Incidence , Intestinal Volvulus , Length of Stay , Meconium , Medical Records , Mortality , Parturition , Premature Birth , Retrospective Studies , Sepsis , Stomach , Tracheoesophageal FistulaABSTRACT
Background: Gastrointestinal hollow viscous perforations constitute one of the important causes of acute pain abdomen in adults and if not treated properly may lead to significant morbidity and sometimes mortality. Successful treatment requires a thorough understanding of anatomy, microbiology, pathophysiology of the disease process and in-depth knowledge of the therapy, including resuscitation, antibiotics, source control, and physiologic support. Aim: To evaluate the etiopathology, clinical signs and symptoms, investigations in the management of gastrointestinal hollow viscous perforations. Materials and Methods: This was a prospective study conducted on patients presenting with gastrointestinal hollow viscous perforations to the Department of General Surgery, Rajarajeswari Medical College and Hospital over a period of 2-year from July 2013 to June 2015. A total of 110 patients were included in the study. A written, informed consent was taken from all patients before enrolling into the study. The Institutional Ethical Committee clearance was taken before starting the study. A pre-formed questionnaire was used to collect the clinical information from the patients. Results: The majority of the patients involved were males (81%) and in the age group of 30-50 years. 80% of the perforations were noted in the Gastroduodenal region, and the remaining was seen in the small bowel (13%) and appendix (7%). Pain abdomen was the presenting complaint in all patients (100%) while vomiting was seen in 50% and abdominal distension was seen in 80% of the patients. 91% of the patients had gas under the diaphragm. Wound infection (9%) lead the list of post-operative complications with a residual abscess (6%) following behind burst abdomen (4%) and fecal fistula (1%). 2% (2 patients) of patients died due to varied reasons. Conclusion: Even after the introduction of proton pump inhibitors, the incidence of perforations resulting from acid peptic disease is still high. Early recognition of perforation, prompt surgical intervention, good post-operative care, recognition of co-morbid conditions and early recognition, and management of complications would reduce morbidity and mortality.
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Gastric perforation in neonates is an unusual, serious and catastrophic condition. Although ischemic, traumatic and spontaneous mechanisms have been proposed for gastric perforation, the exact etiology is not clear. Both early diagnosis and treatment is very important to improve survival. We hereby report three cases of neonatal gastric perforation managed successfully by early resuscitation efforts and prompt laparotomy.
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Gastrointestinal perforation is one of the common complications of various illness that is associated with high mortality and morbidity. The common sites of perforation in GIT (gastrointestinal tract) are stomach, duodenum, ileum and colon, but in dengue perforation in any of the above site is rare. Here we report an interesting case of gastric perforation that occurred in a young male patient post dengue fever. To our knowledge, this is the first such case of gastric perforation that occurred in our patient with dengue that we are reporting in the literature.
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Neonatal gastric perforation is a rare but fatal disease, occurred mainly in preterm infants. In general, primary surgical repair is the main treatment. To the best of our knowledge, there has been only one report of improvement of gastric perforation in neonates after percutaneous peritoneal drainage alone. We describe a case of gastric perforation in a premature extremely low-birth-weight infant girl of 25(+4) weeks gestational age. We present this case to emphasize that gastric perforation may improve with percutaneous peritoneal drainage.
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Female , Humans , Infant, Newborn , Drainage , Gestational Age , Infant, Extremely Low Birth Weight , Infant, Low Birth Weight , Infant, PrematureABSTRACT
Gastric perforation (GP) of the neonate is a rare, serious, and fatal complication of uncertain etiology. This report describes the case of a 3 days female patient presenting with gastric perforation.
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Objective To investigate the etiology,clinical features and prognosis of neonatal gastric perforation.Methods The medical records of 18 patients with neonatal gastric perforation with respect to sex,age,birth-weight,course of disease,clinical presentations,and prognosis were retrospectively analyzed.Results There were 13 boys and 5 girls,8 of whom were full term infants and 10 preterm infants.The most common initial manifestations were poor activity,abdominal distension,and respiratory distress.All neonates were treated by surgical operation,the overall survival rate was 11/18.Prematurity,birth-weight,course of disease,were the statistically significant risk factors (P ＜ 0.05).Conclusions Neonatal gastric perfora tion is mainly caused by congenital gastric wall defect,and associated with high mortality,particularly in premature infants.It is necessary to early diagnosis,surgical operation in time,nurse intensively,and observe the condition closely.
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PURPOSE: The purpose of this study was to compare the clinical findings and mortality of gastric perforation between preterm and term infants. METHODS: The medical records of neonates, admitted to the neonatal intensive care unit of Dongsan Medical Center for gastric perforation between July 1992 and June 2012, were reviewed retrospectively. The admission records of clinical findings and mortality were reviewed and statistically analyzed between preterm and term infants. RESULTS: Nine infants were diagnosed with neonatal gastric perforation. Of the nine infants, the number of term infants was five and the number of male was eight. Of the four infants diagnosed with spontaneous gastric perforation, the number of preterm and term infants was three and one respectively. The anatomical location of perforation was greater curvature in all four preterm infants. However, various sites such as greater curvature (three infants) and antrum (two infants) were observed in five term infants. Mortality rate was tended to be lower in preterm infants compared to term infants, without statistical significance (25.0% vs. 40.0%, P>0.1). There was no mortality in four infants diagnosed with spontaneous gastric perforation. However, two infants diagnosed with necrotizing enterocolitis (NEC) all died. CONCLUSION: There was no significant difference in clinical findings and mortality of gastric perforation between preterm and term infants. The prognosis of spontaneous gastric perforation was good, however, mortality rate was tended to be higher in NEC than other causes (P=0.083).
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Humans , Infant , Infant, Newborn , Male , Enterocolitis, Necrotizing , Infant, Premature , Intensive Care, Neonatal , Medical Records , Prognosis , Retrospective StudiesABSTRACT
Introducción: presentándose como una verdadera emergencia quirúrgica, la perforación gástrica neonatal constituye un reto para todos los galenos que laboran en este campo. Objetivo: exponer los resultados de nuestra experiencia en el tratamiento de recién nacidos con perforación gástrica, y revisar el estado actual del conocimiento sobre esta nosología. Métodos: se realizó una investigación descriptiva, retrospectiva, con la totalidad de los recién nacidos ingresados en la sala de neonatología quirúrgica del Hospital Pediátrico Universitario William Soler, diagnosticados con perforación gástrica, durante el período comprendido entre enero de 1990 y diciembre de 2010. Resultados: se trataron 8 pacientes, de los cuales 3 se consideraron como idiopáticos. El neumoperitoneo estuvo presente en la totalidad de los pacientes. El fundus gástrico y la cara anterior del óirgano constituyeron los sitios más frecuentemente afectados. Por su lado, la prematuridad no guardó una clara relación con la ocurrencia de la perforación. En la mayoría de los pacientes se realizó una reparación primaria de la perforación sin gastrostomía. La mortalidad general en el estudio fue de un 62 por ciento, y fue la peritonitis la complicación más frecuente. Conclusiones: la perforación gástrica neonatal constituye una entidad altamente letal, en la cual las distintas alternativas de tratamiento quirúrgico no son, en definitiva, por sí solas, la solución para lograr una adecuada sobrevida
Introduction: present like a real surgical emergence, the neonatal gastric perforation is a challenge for all physicians working in this field. Objective: to show the results of our experience with the treatment of newborns presenting with gastric perforation and also to review the current state of knowledge on this nosology. Methods: a retrospective and descriptive research was conducted in all the newborns admitted in the surgical neonatology ward of the William Soler University Children Hospital, diagnosed with a gastric perforation, from January, 1990 to December, 2010. Results: eight patients were treat concluded that three were idiopathic. The fundus of the stomach and the organ's anterior face were the more frequently involved sites. By his part, the prematurity hasn't an evident relationship with the occurrence of perforation. In most of patients a primary repair of the perforation without gastrotomy was carried out. The general morality in present study was of 62 percent and the peritonitis was the more frequent complication. Conclusions: the neonatal gastric perforation is a highly lethal entity in which the different alternatives of surgical treatment are not anyway by themselves, the solution to achieve an appropriate survival
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An unusual case of suicidal nitric acid ingestion is being reported in a 24 year-old factory worker, with classical postmortem features of xanthoproteic reaction and necrotic perforation of stomach.