PDF(Pubmed)
Abstract：
BACKGROUND: Spontaneous gastric perforation of the neonate is a rare phenomenon with a high risk of mortality. Despite an uncertain etiology, an association with prematurity and low-birth weight has been demonstrated. Prompt surgical repair and intensive care remain imperative to survival.
METHODS: A premature, low-birth weight male was born at 32 weeks and admitted to the NICU for respiratory distress syndrome. Forty-eight hours after birth he developed abdominal distention and an abdominal radiograph demonstrated pneumoperitoneum. Antibiotics were initiated and he was taken for emergent operative exploration. A 3 cm longitudinal perforation was identified in the greater curvature of the stomach. A two-layered repair was performed and a protective Stamm gastrostomy created. On postoperative day 10, an upper gastrointestinal contrast study demonstrated no evidence of leakage. After sustained clinical improvement, the initiation of oral feeding, and continued weight gain, the neonate was successfully discharged home.
CONCLUSIONS: The etiology of spontaneous gastric perforation remains a debate with several proposed mechanisms. In most cases, the neonate will present with abdominal distention and emesis. Although presentation and evidence of pneumoperitoneum on abdominal radiograph are suspicious for this pathology, definitive diagnosis is confirmed during operative exploration. Dedicated intensive care and prompt surgical repair are paramount to survival. Despite decreasing mortality rates, premature and low-birth weight neonates continue to have the lowest rates of survival.
CONCLUSIONS: We present a rare case of a premature, low-birth weight neonate who developed spontaneous gastric perforation and was successfully rescued using a coordinated multidisciplinary approach enabling prompt diagnosis and surgical repair.
METHODS: A premature, low-birth weight male was born at 32 weeks and admitted to the NICU for respiratory distress syndrome. Forty-eight hours after birth he developed abdominal distention and an abdominal radiograph demonstrated pneumoperitoneum. Antibiotics were initiated and he was taken for emergent operative exploration. A 3 cm longitudinal perforation was identified in the greater curvature of the stomach. A two-layered repair was performed and a protective Stamm gastrostomy created. On postoperative day 10, an upper gastrointestinal contrast study demonstrated no evidence of leakage. After sustained clinical improvement, the initiation of oral feeding, and continued weight gain, the neonate was successfully discharged home.
CONCLUSIONS: The etiology of spontaneous gastric perforation remains a debate with several proposed mechanisms. In most cases, the neonate will present with abdominal distention and emesis. Although presentation and evidence of pneumoperitoneum on abdominal radiograph are suspicious for this pathology, definitive diagnosis is confirmed during operative exploration. Dedicated intensive care and prompt surgical repair are paramount to survival. Despite decreasing mortality rates, premature and low-birth weight neonates continue to have the lowest rates of survival.
CONCLUSIONS: We present a rare case of a premature, low-birth weight neonate who developed spontaneous gastric perforation and was successfully rescued using a coordinated multidisciplinary approach enabling prompt diagnosis and surgical repair.
摘要：
背景：新生儿自发性胃穿孔是一种罕见的现象，具有很高的死亡风险。尽管病因不确定，已证明与早产和低出生体重相关.及时的手术修复和重症监护仍然是生存的必要条件。
方法：过早，低出生体重男性出生32周时因呼吸窘迫综合征进入NICU.出生48小时后，他出现腹胀，腹部X光片显示气腹。开始使用抗生素，并将其进行紧急手术探索。在胃的较大曲率中发现了3厘米的纵向穿孔。进行了两层修复，并创建了保护性Stamm胃造口术。术后第10天，上消化道造影研究未显示渗漏的迹象。经过持续的临床改善，开始口服喂养，体重持续增加，新生儿成功出院回家。
结论：自发性胃穿孔的病因仍存在争议，有几种可能的机制。在大多数情况下,新生儿会出现腹胀和呕吐。尽管腹部X线片上气腹的表现和证据对这种病理可疑，明确的诊断在手术探查中得到证实。专门的重症监护和及时的手术修复对生存至关重要。尽管死亡率下降，早产和低出生体重新生儿的存活率仍然最低。
结论：我们提出了一个罕见的早产病例，低出生体重新生儿发生自发性胃穿孔，并使用协调的多学科方法成功抢救，从而能够及时诊断和手术修复。
方法：过早，低出生体重男性出生32周时因呼吸窘迫综合征进入NICU.出生48小时后，他出现腹胀，腹部X光片显示气腹。开始使用抗生素，并将其进行紧急手术探索。在胃的较大曲率中发现了3厘米的纵向穿孔。进行了两层修复，并创建了保护性Stamm胃造口术。术后第10天，上消化道造影研究未显示渗漏的迹象。经过持续的临床改善，开始口服喂养，体重持续增加，新生儿成功出院回家。
结论：自发性胃穿孔的病因仍存在争议，有几种可能的机制。在大多数情况下,新生儿会出现腹胀和呕吐。尽管腹部X线片上气腹的表现和证据对这种病理可疑，明确的诊断在手术探查中得到证实。专门的重症监护和及时的手术修复对生存至关重要。尽管死亡率下降，早产和低出生体重新生儿的存活率仍然最低。
结论：我们提出了一个罕见的早产病例，低出生体重新生儿发生自发性胃穿孔，并使用协调的多学科方法成功抢救，从而能够及时诊断和手术修复。
