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.

背景：新生兒胃穿孔是罕見的外科急症，過去發病率和死亡率較高。方法：我們報導了一例罕見的足月新生女嬰胃穿孔的病因，出生體重為2.9公斤，出生後2天腹部X線發現氣腹，急診剖腹探查發現胃穿孔，行一期胃修補術及胃造瘺引流術。結果：患兒術後出現長時間的餵養不耐受及非膽汁性嘔吐。複查胃造影及通暢情況，發現造影劑順利通過並進入十二指腸和小腸。由於保守治療胃食管反流及胃動力障礙失敗而行二次剖腹探查，發現前壺腹部開口的十二指腸蹼導致了十二指腸不全性梗阻。患兒行十二指腸側側吻合術後出院前能正常進食。討論：本文討論了文獻報導的各種新生兒胃穿孔的原因，以及十二指腸不全梗阻的診斷的難處在於前壺腹部開口的十二指腸蹼。