The Case of Pseudocyst Formation after Spontaneous Neonatal Gastric Perforation

Spontaneous gastric perforation of the newborn is a rare, serious and life-threatening problem. This is surgical emergency because of high mortality. Most historical reports have described gastric perforation in the neonate as spontaneous cause. But, recent reviews report the contributing factor including prematurity and mechanical ventilation. Usually clinician identifies the pneumoperitoneum in simple abdomen X-ray. The final diagnostic method is surgical finding and the treatment of gastric perforation is immediate surgical correction. Early diagnosis, hemodynamic monitoring and fluid therapy for hypovolemia improve outcome. Pseudocyst formation after gastric perforation is very rare in newborn. We report a rare case of pseudocyst formation after spontaneous gastric perforation in full term newborn.

Clinical Features of Spontaneous Neonatal Gastric Perforation

PURPOSE: Spontaneous neonatal gastric perforation is a rare neonatal event which is associated with high mortality. The aim of this retrospective study is to investigate the diagnosis and the treatment of neonatal spontaneous gastric perforation. METHODS: From January 1991 to December 2000, eight cases of neonatal gastric perforation were presented at Keimyung University Dongsan Medical Center. RESULTS: Among 8 neonates (7 males and 1 females), 2 were premature infants. 7 cases (87.5%) had symptoms onset in first 4 days of life. The most presenting signs were abdominal distension, vomiting, and respiratory difficulty. The most common X-ray finding was pneumoperitoneum (87.5%) and the most common site of perforation was greater curvature (75%). The combined congenital anomalies were malrotation of small intestine, teratoma, and partial duodenal obstruction. The predisposing causes may be associated with congenital intestinal anomaly, necrotizing enterocolitis, and too fast increased formula. All the cases underwent surgical repairs. The mortality rate was 37.5%, and the surgical procedure performed 24 hours after presumed disease onset represented poor outcome (mortality rate 67%). CONCLUSION: This report suggests that early diagnosis and early management before clinical deterioration of metabolic status may improve the prognosis for neonatal spontaneous gastric perforation patient.