PMY Tang, JWS Hung, CSW Liu, MWY Leung

Abstract

Background: Neonatal gastric perforation is an uncommon surgical emergency. It is often associated with high mortality and morbidity in the past. Methods: We present a case of a full term neonate with an uncommon cause of gastric perforation. A full term baby girl with a body weight of 2.9 kg presented with pneumo-peritoneum on abdominal X-ray on day two of life. Emergency laparotomy revealed gastric fundal perforation, primary gastric repair and drainage gastrostomy were done. Results: The baby's post operative recovery was complicated with prolonged feeding intolerance with non-bilious vomiting. Repeated contrast gastrograms and follow-through revealed satisfactory contrast passage into duodenum and small bowel. Failing to respond to conservative management for gastro-oesophageal reflux disease and gastric dysmotility, a second exploratory laparotomy was performed. A pre-ampullary fenestrated duodenal web causing incomplete duodenal obstruction was found. A side to side duodeno-duodenostomy was done and the baby finally tolerated normal feeding postoperatively before discharge. Discussion: We discuss the different etiologies for neonatal gastric perforation with review of literature, and also the diagnostic difficulties in infants with incomplete duodenal obstruction due to pre-ampullary fenestrated duodenal web.