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HK J Paediatr (New Series)
Vol 21. No. 2,
2016
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HK J Paediatr (New Series) 2016;21:109-112
Case Report
An Uncommon Cause of Neonatal Gastric Perforation: A Case Report
PMY Tang, JWS Hung, CSW Liu, MWY Leung Division of Paediatric Surgery, Department of Surgery, Queen Elizabeth Hospital & United Christian Hospital, Hong Kong, China PMY Tang (鄧敏儀) FRCS(Paed Surg), FHKAM JWS Hung (孔詠雪) MBBS, MRCS(Surg) CSW Liu (廖思維) FRCS(Paed Surg), FHKAM MWY Leung (梁偉業) FRCS(Paed Surg), FHKAM Correspondence to: Dr PMY Tang Received June 18, 2015
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. Keyword : Neonatal gastric perforation Abstract in Chinese
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