Idiopathic Double Perforation of the Gastrointestinal Tract

A 73-year old woman was operated on with diffuse peritonitis and multiple abscesses throughout the mesentery which were drained. After the operation the patient could not recover. After an indicative computerized tomography the patient was re-explored. Perforation of the ileum and gastric perforation at the pylorus were found. There was no history of underline disease. The double perforation of the GI tract was surgically managed but the patient's course was fatal.

THE OVER-THE-SCOPE-CLIP FOR THE TREATMENT OF THE DIGESTIVE TUBE LEAKS AND TEARS: A CASE-SERIES

Digestive tube damages represent a therapeutic challenge for the gastrointestinal endoscopists. Recenty, a novel device – the-over-the-scope clip (OTSC) – has been introduced for non-surgical treatment of gastrointestinal perforations, fi stula, anastomotic leaks and refractory gastrointestinal bleeds. This study aimed to evaluate the therapeutic effi cacy of OTSC in our case series. A total of nine patients were included (six males, medain age 72 years, range 58-86). The indications were upper gastrointestinal bleeding (refractory to standard endoscopic treatment: fi ve patients, a vessel with a large caliber: one patient), fi stula in two patients, and iatrogenic perforation of the sigmoid colon in one patient. Atraumatic and traumatic versions of OTSCs with twin graspers were used. All of the patients were treated with only one OTSC, and none of the patients required additional endoscopic treatment. The OTSC procedure had 100% technical success. In a subgroup of patients with perforation and fi stulae, the clinical success was 67%, whereas in those with the bleedings it was 50%. The median follow-up was 34 days (range: 3-452). OTSC is a safe and effective device for closure of perforations and leaks. However therapeutic effi cacy was subopimal in patients with the upper gastrointestinal bleedings possibly due to the application of the sharp-teeth OTSC.

Pseudoaneurysm of the inferior phrenic artery presenting as an upper gastrointestinal bleed by directly rupturing into the stomach in a patient with chronic pancreatitis

Pseudoaneurysms occurring in patients with chronic pancreatitis are associated with significant morbidity and mortality. These pseudoaneurysms occur more commonly in the splenic, pancreaticoduodenal, and gastroduodenal arteries. Upper gastrointestinal bleeding (UGIB) due to pseudoaneurysms in patients with pancreatitis with pseudocyst usually presents as hemosuccus pancreaticus. However, pseudoaneurysm directly perforating the gastrointestinal tract and presenting as UGIB is a rare complication. We report here the first case of UGIB from the inferior left phrenic artery pseudoaneurysm rupturing directly into the stomach of a patient with chronic pancreatitis.

Gastric rupture with necrosis following acute gastric dilatation: report of a case

Gastric rupture with necrosis following acute gastric dilatation (AGD) is a rare and potentially fatal event; usually seen in patients with eating disorders such as anorexia nervosa or bulimia. A 12-year-old lean boy with no remarkable medical history was brought to our Emergency Department suffering acute abdominal symptoms. Emergency laparotomy revealed massive gastric dilatation and partial necrosis, with rupture of the anterior wall of the fundus of the stomach. We performed partial gastrectomy and the patient recovered uneventfully. We report this case to demonstrate that AGD and subsequent gastric rupture can occur in patients without any underlying disorders and that just a low body mass index is a risk factor for this potentially fatal condition.

Etiology of neonatal gastric perforation: a review of 20 years' experience

PURPOSE

Gastric perforation (GP) of the newborn is a rare, serious, and life-threatening problem, and its etiology remains unclear. Although historically GP has often been described as "spontaneous'', some cases are non-spontaneous. The aim of the present study was to review cases of GP and to discuss its etiology in a single prefecture in Japan over a period of 20 years.

METHODS

Eleven cases with GP that underwent surgery in 4 institutions in the Chiba Prefecture from 1991 to 2010 were reviewed and divided into 2 groups: the early (1991-2000, n = 7) and late (2001-2010, n = 4) groups.

RESULTS

No factors were observed that could have caused GP other than malformations associated with distal obstruction (3 midgut volvulus, 1 jejunal stenosis, 1 diaphragm eventration). Distal obstruction was present in 1 case in the early group and all 4 cases in the late group (p = 0.015). While the incidence of GP did not change over the 20-year period reviewed, the incidence of GP without distal obstruction significantly decreased in the late group.

CONCLUSION

The proportion of patients with GP and distal obstruction increased and true "spontaneous" cases of GP decreased over time. The possible presence of distal obstruction should be evaluated during surgery for GP.

[Laparoscopic treatment of a large trichobezoar in the stomach with gastric perforation and abdominal wall abscess]

Trichobezoar represents a mass of swallowed hair inside the stomach. Here we report a 17-year-old girl who presented in our department with symptoms of gastric ulcer. Ultrasound examination followed by upper endoscopy revealed a large trichobezoar in the stomach with simultaneous gastric perforation. Laparoscopy also revealed a penetration into the anterior abdominal wall accompanied by abscess at this level. We performed a laparoscopic gastrotomy with trichobezoar extraction and laparoscopic treatment of perforation and abdominal wall abscess. The postoperative evolution was normal and the patient was discharged on the fifth postoperative day. We show that laparoscopic approach may be safely used in the treatment of the large gastric complicated trichobezoar. Several laparoscopic approaches were described for the treatment of tricobezoar and its complications but as far as we know this is the first report of laparoscopic treatment of large tricobezoar and associate gastric perforation.

[A rare cause of pneumoperitoneum]

We provide the description of a 77 year old patient, admitted into the IC unit, with whom the surgical intervention was required by the presence of a massive pneumoperitoneum observed during abdominal CT. Anamnestic and clinical information was scarce; the patient had been admitted into the gastroenterology unit with the following diagnosis: acute pancreatitis, renal failure, atrioventricular block, while the hemodynamic instability made hospitalisation into the IC unit mandatory. Anatomopathological lesions secondary to a major vascular damage at the level of the celiac trunk and at the superior mesenteric level were noticed intraoperatively: total gastric necrosis with perforation, splenic infarction, entero-mesenteric infarction, abdominal wall necrosis. The patient did not allow for a surgical solution. The anatomopathological examination of the gastric tissue fragment enabled the diagnosis of extensive gangrene of the gastric wall. The relevance of the case consists in the presence of an abdominal vascular damage detected in full development, where the pneumoperitoneum required surgical exploration. The intricacy of the anatomopathological lesions accounts for the acute painful abdominal onset, accompanied by quick hemodynamic, clinical, and biochemical deterioration. Thus, gastric perforation through rupture secondary to total gastric gangrene of vascular origin joins the many causes of pneumoperitoneum.

Transection of the stomach after blunt injury in the pediatric population

The incidence of gastric rupture after abdominal blunt injury ranges between 0.02% and 1.7% and is associated with a high morbidity (Tejerina Alvarez EE, Holanda MS, Lopex-Espadas F, Dominguez MJ, Ots E, Diaz-Reganon J. Gastric rupture from blunt abdominal trauma. Injury. 2004;35:228-231, Allen GS, Moore FA, Cox CS. Hollow visceral injury and blunt trauma. J Trauma. 1998;45:69-75.). Stomach transection represents an even rarer type of blunt gastric injury. Although not specifically included in the accepted classification of stomach injury, its clinical manifestation is dramatic, requiring immediate surgical management. We present a case report from our institution and reviewed the international literature focusing on the pediatric patient to illustrate this injury in terms of mechanism of injury, clinical presentation, and surgical management.

Predictors of gastrointestinal perforation in patients undergoing coronary artery bypass graft (CABG) surgery in Tehran, Iran

BACKGROUND

Gastrointestinal perforation after coronary artery bypass graft (CABG) surgery is often difficult to diagnose and is associated with high morbidity and mortality rates. The aim of this study was to determine risk factors for this complication in the studied population to further improve prophylaxis and diagnosis in the region of study.

METHODS

Of 8,975 consecutive patients undergoing CABG during 10 years (1995-2005), 15 (0.16%) developed gastrointestinal perforation requiring laparatomy. Data from patients who experienced gastrointestinal perforation were analyzed using univariate tests in a controlled retrospective design.

RESULTS

Prolonged bypass time and preoperative heparin administration were found to be significant (P<0.05) risk factors.

CONCLUSION

Low splanchnic blood flow and vasoconstriction might be underlying factors associated with both predictors. With current findings, however, clear inference about preoperative and postoperative predictors and their relation is not possible. With more information, the next step would be to build a prediction model in recognition of gastrointestinal perforation after CABG on the basis of the predisposing factors.

Gastric rupture and necrosis in Prader-Willi syndrome

Hyperphagia and obesity are common features in individuals with Prader-Willi syndrome (PWS). Demographic and cause-of-death data from individuals with PWS were obtained through a national support organization. Four reports of unexpected mortality due to gastric rupture and necrosis were found in 152 reported deaths, accounting for 3% of the causes of mortality. Four additional individuals were suspected to have gastric rupture. Vomiting and abdominal pain, although rare in PWS, were frequent findings in this cohort. The physician should consider an emergent evaluation for gastric rupture and necrosis in individuals with PWS who present with vomiting and abdominal pain.

Acute transhiatal migration and herniation of fundic wrap following laparoscopic nissen fundoplication

Acute transhiatal wrap herniation can occur in the early postoperative period following laparoscopic Nissen fundoplication due to events which can raise intra-abdominal pressure. Of a total of 264 patients who underwent laparoscopic Nissen fundoplication in our series, two developed acute transhiatal wrap herniation, 8 and 12 weeks after the procedure, respectively. Prompt referral to our unit with early diagnosis and laparoscopic reduction of the hernia resulted in an uneventful recovery in one patient. Delay in recognition and referral for the other patient resulted in strangulation and perforation of the stomach in the posterior mediastinum, necessitating laparotomy and resection of the gastric fundus. Awareness and a high index of suspicion are necessary to detect and treat the condition early, thereby averting a potentially life-threatening clinical situation. Herniation, if detected early, can be treated by the laparoscopic approach. Satisfactory outcomes in the management of wrap migration following laparoscopic Nissen fundoplication hinge on early recognition and prompt surgical intervention. It is important to recognize and prevent factors that lead to anatomical failure of the operation. Methods to fix the fundic wrap and the benefits of using prosthetic material for crural repair need to be considered.

Gastric incarceration and perforation following posttraumatic diaphragmatic hernia: case report and review of the literature

OBJECTIVE

Herniation of abdominal contents through the diaphragm has been described in a variety of diaphragmatic defects and may occur secondary to diaphragmatic injury, either traumatic or iatrogenic. The aim of this study is to report a case of gastro-pleural fistula in a patient with traumatic diaphragmatic hernia.

CASE PRESENTATION

An 18-year-old male patient, with a past history of blunt abdominal trauma, presented with epigastric abdominal pain and dyspnea. A thoracoabdominal CT scan revealed the presence of a herniated portion of the stomach with suspected perforation and free fluid in the left hemithorax. An exploratory laparotomy was performed. The esophageal hiatus was normal but a 4 cm rent was discovered in the posterior leaf of the left hemidiaphragm. Passing through the defect was the fundus of the stomach with evidence of perforation in left pleural space causing empyema. Resection of the herniated portion of the stomach and running suture of the gastric body were performed. Diaphragm was directly repaired without graft. Finally, a chest tube was placed in the left hemithorax. Postoperative course was uneventful and he recovered without complications. He was discharged from hospital 13 days after surgery.

Gastrointestinal perforation in very low-birthweight infants

BACKGROUND

Spontaneous isolated gastrointestinal perforation (SIP) in very low-birthweight infants has been reported as a different disease entity from necrotizing enterocolitis (NEC). The objective of this study was to investigate the incidence and risk factors of NEC and SIP.

METHODS

The authors reviewed the medical records of very low-birthweight infants who were admitted to Toho University Perinatal Center, Tokyo, Japan, between 1 January 1991 and 31 December 2002. The diagnosis of NEC was made with the finding of bloody gastric fluid or stool, abdominal distention, and abnormal abdominal X-ray findings such as pneumatosis intestinalis or fixed dilated intestinal loops. SIP was defined at laparotomy as the presence of an isolated gastrointestinal perforation surrounded by normal appearing bowel.

RESULTS

A total of 556 very low-birthweight infants were included in this study. Of those, 15 infants were excluded because of major anomalies. Out of 541 infants, 14 were diagnosed to have NEC or gastrointestinal perforation. In total, 13 infants had gastrointestinal perforation and 10 were confirmed as SIP. Two SIP suggestive cases were included in SIP cases. There was only one case of NEC (0.2%) during 12 years in the authors' institute. Eight SIP cases had antenatal nonsteroidal anti-inflammatory drugs (NSAID). The treatment with antenatal NSAID was significantly associated with the incidence of SIP (p<0.001).

CONCLUSION

The authors experienced only one proven case of NEC (0.2%), 12 cases of SIP (2.2%) among 556 very low-birthweight infants admitted during 12 years. Antenatal NSAID were strongly associated with SIP.

Gastric rupture associated with diaphragmatic hernia during pregnancy

Diaphragmatic hernia complicating pregnancy rarely occurs, but it is frequently misdiagnosed. A strangulated diaphragmatic hernia in a pregnant patient presents a true surgical emergency, and delay in operative intervention can result in fetal and maternal mortality in as many as 50% of cases. We describe a case report of a pregnant patient and her fetus surviving after a spontaneous gastric rupture from a strangulated diaphragmatic hernia.

Intrauterine gastric perforation

We describe a case of intrauterine gastric perforation in a 31-week gestational age baby girl. The patient presented at birth with abdominal distension, respiratory distress, and massive pneumoperitoneum on radiography. The perforation was managed by resuscitation, celiotomy, and gastrostomy tube placement through the site of perforation. This is the second report of an intrauterine gastric perforation in the literature.

Traumatic prepyloric transection: unusual injury in a child

The diagnosis and management of a 14-year-old girl with isolated traumatic transection of the prepylorus after a motor vehicle accident are presented. Abdominal computed tomography was useful in the diagnosis of pneumoperitoneum associated with hollow viscous injury. Rapid diagnosis and surgical repair of this unusual injury resulted in an uncomplicated recovery.

Spontaneous gastric perforation in a neonate presenting with massive hydroperitoneum

We report the imaging findings in a case of neonatal spontaneous gastric perforation presenting as massive hydroperitoneum rather than pneumoperitoneum. Plain abdominal radiography showed a diffuse ground-glass opacity with paucity of bowel gas. Subsequent ultrasonography demonstrated numerous echogenic peritoneal fluid collections containing echogenic debris shown at surgery to be due to milk and bile.

Nécrose gastrique après gastroplastie

INTRODUCTION

Over the past ten years, laparoscopic surgery in the treatment of morbid obesity has expanded. However, there are few publications describing its side effects, notably the occurrence of gastric necrosis.

OBSERVATION

Two years after laparoscopic-banding for morbid obesity, a case of acute gastroenteritis in a 45 Year-old woman proved to be a gastric necrosis.

COMMENTS

Relatively unknown, this complication is generally revealed by non-specific clinical signs. Only emergency oeso-gastro-duodenal opacification permits diagnosis. Early diagnosis permits conservative treatment before the onset of necrosis.

CONCLUSION

Care must be taken when using this technique, which has not yet proved its innocuousness, and regular follow-up of the patient is crucial.

Characteristic features of abdominal organ injuries associated with gastric rupture in blunt abdominal trauma

BACKGROUND

Previous studies have investigated the mechanisms of gastric rupture based only on the findings in gastric rupture and excluding gastric lacerations.

METHODS

We investigated 14 cases of gastric injury (five with rupture and nine with laceration) from blunt abdominal trauma with or without thoracic trauma. Gastric injuries were caused by a traffic accident in 12 and by a fall in two patients. All of the patients with gastric rupture had had a full stomach at the time of impact.

RESULTS

The patients had associated injuries of adjacent solid organs, the thoracic cage, and extremities. The frequency of injury of the hepatoduodenal or gastrohepatic ligament was higher in patients with gastric laceration than in patients with gastric rupture. Eight of nine patients with a gastric laceration had hepatic or pancreatic injury, whereas none of the patients with gastric rupture had such injury.

CONCLUSIONS

The results of our study showed that the distended stomach tends to rupture by absorbing the impact from blunt abdominal trauma (i.e., it works like an airbag to protecting adjacent organs such as the liver and pancreas).

Sudden unexpected death due to rupture of the stomach

We report a case of sudden unexpected death due to rupture of the stomach. A 49-year-old man was found dead in a public lavatory. Autopsy findings revealed two rupture wounds measuring 14 cm and 6 cm located in the fundus of stomach at the side of the greater curvature despite of any superficial injury. The deceased had an ulcer in the lesser curvature of stomach, and dilation in this area was expected to be impaired. Under this condition, excessive over-eating resulting in over-extension of the stomach wall at the greater curvature was speculated to have caused stomach rupture.

Spontaneous pneumoperitoneum in two cats

Spontaneous pneumoperitoneum is an infrequently observed presentation in cats. This report details two cases of pneumoperitoneum in the cat. The first case was suspected to have been caused by a gastric perforation secondary to gastric lymphoma. The second case was caused by a perforated gastric ulcer in a cat that had been recently treated with corticosteroids and a non-steroidal anti-inflammatory drug.

Unusual presentation of gastric duplication cyst in a neonate with pneumoperitoneum and vertebral anomalies

An unusual case of communicating, tubular gastric duplication (GD) of the greater curvature of the stomach presenting with pneumoperitoneum is described. The pneumoperitoneum resulted due to simultaneous mechanical rupture of stomach and its duplication cyst due to birth trauma and vigorous post delivery resuscitation. No case of this kind has been reported earlier in English literature, though instances of ulcerative perforation of neonatal stomach and GD are known. There was radiographic evidence of multiple thoracic vertebral anomalies, again a rare occurrence with GD cyst. Further, a diagnostic dilemma was faced in this patient as the presence of radiographic sign of "gastric bubble" on plain radiographs in this patient suggested the source of free intraperitoneal air to be extragastric and the diagnosis could be made only at surgery. The authors have reviewed the pertinent literature on neonatal gastric perforation and GD cysts and uphold "split notochord" theory as etiology for GD in this patient.

Spontaneous neonatal gastric perforation

Over a 7-year period (1990-1997) spontaneous gastric perforation was diagnosed in five neonates. The mean gestational age and birth weight were 33/40 weeks and 1.83 kg, respectively. All patients presented with severe abdominal distention and frank pneumoperitoneum on roentgenograms. All perforations were on the anterior wall of the greater curvature and were managed by prompt laparotomy and primary closure of the perforation. No gastrostomy was used, however, peritoneal drainage was used in all cases. There was no mortality or morbidity. An attempt to understand the possible etiology together with a review of the literature is presented.

Gastric rupture and massive pneumoperitoneum after bystander cardiopulmonary resuscitation

Gastric perforation is a rare complication of cardiopulmonary resuscitation. The majority of reported cases have been associated with difficult airway management or esophageal intubation. There has been only one previous case report in which this complication could be attributed solely to mouth-to-mouth ventilation. We present a case of simple bystander cardiopulmonary resuscitation that resulted in gastric perforation.

Gastric incarceration and perforation following posttraumatic diaphragmatic hernia

We report the case of a 36-year-old male patient who developed gastric incarceration and perforation in a diaphragmatic hernia 8 months after an automobile accident. During emergency surgery, protrusion of the stomach into the thoracic cavity and perforation on the anterior aspect of the stomach were noted. The gastric perforation and the diaphragmatic defect were closed. During the postoperative course, the patient developed sepsis and coagulopathy that subsided following medical therapy. In order to prevent severe complications, surgery is indicated as soon as conclusive diagnosis is made.

Gastric wall erosion by an amebic liver abscess in a 3-year-old girl

The occurrence of an amebic liver abscess (ALA) rupturing into the stomach is reported. ALAs in children can have atypical presentations, resulting in delayed diagnosis and increased morbidity and mortality. Timely treatment is usually followed by complete recovery.

Blunt injuries of the stomach

OBJECTIVE

To evaluate the results of surgical treatment of patients with blunt injuries of the stomach.

DESIGN

Retrospective study.

SETTING

Two general hospitals, Greece.

SUBJECTS

10 patients operated on for blunt trauma to the stomach during a 10 year period.

MAIN OUTCOME MEASURES

Hospital mortality and morbidity.

RESULTS

All patients were victims of motor vehicle accidents and presented with clinical signs warranting early laparotomy. There were 6 full-thickness, and 2 partial thickness gastric injuries located in the anterior wall. All injuries could be managed with simple surgical techniques without resections. Two patients bled to death on the operating table from associated injuries. All but one of the survivors had postoperative complications with a mean (SD) duration of hospital stay of 18(8) days (range 10-30).

CONCLUSIONS

Blunt gastric injury is usually diagnosed at laparotomy for associated injuries but may occasionally be suspected from specific clinical findings. In most cases the injury is on the anterior wall. Simple repair is usually sufficient and the prognosis depends on the severity of the associated injuries.

[Stomach rupture due to barotrauma (a report of the 13th case since 1969)]

The thirteenth case of rupture of the stomach after a diving accident since 1969 is reported. This rare event was caused by equipment failure and panic reaction, which induced swallowing air during diving and consequential gas expansion in gastric cavity meanwhile the rapid ascent. Peritoneal decompression by paracentesis quickly improved the patient's condition and the following surgical laparotomy revealed a gastric tear along the lesser curvature, which was closed by suturing. The patient presented a postoperative splenic abscess two months later; literature demonstrated that rupture of a filled stomach may lead to septic complications.

Conservative management of gastric rupture following scuba diving

Gastric rupture is an uncommon surgical problem which normally presents with an acute abdomen and peritonism. An unusual case following underwater ascent and its conservative management is presented.

Gastric emphysema simulating perforated hollow viscus: case report and review of literature

Gastric emphysema is a benign condition in which air from non bacterial sources accumulate within the wall of the stomach. This pathology is usually associated with gastric and, or small bowel obstruction. A case report of gastric emphysema is presented, together with a pertinent review of the literature.

Gastric rupture--an uncommon complication after successful cardiopulmonary resuscitation: report of two cases

Gastric rupture is a poorly described complication following cardiopulmonary resuscitation. An incidence of 0.1% has been reported in the literature. Published reports describe traumatic gastric rupture after use of the CardioPump, after mouth-to-mouth ventilation, and in children after resuscitation performed by paramedics. We report on two patients who developed gastric rupture after successful standard cardiopulmonary resuscitation. Preexisting gastric ulcerations or osseous trauma during resuscitation had been excluded. Neither patient developed abdominal symptoms; in both cases the gastric rupture was diagnosed by routine chest X-ray and both patients underwent-after stabilization-surgical treatment. One patient recovered well, but the other developed cardiogenic shock due to malignant arrhythmias and severely impaired left ventricular function. This patient died on the 6th postinterventional day. Gastric rupture rarely occurs after cardiopulmonary resuscitation. The causes of gastric rupture and the means to avoid this complication will be discussed.

Traumatic gastric transection: a case report

This report documents the first known pediatric survivor of seat-belt-associated gastric transection. An 11-year-old boy presented with abdominal ecchymoses after a motor vehicle accident. Physical and radiological examination determined the need for abdominal exploration. During the operation, a near-complete transection of the stomach was found, which was repaired by primary anastomosis. After an initially unremarkable recovery period, gastric stasis and pyloric obstruction developed. Radiologically and endoscopically, this was determined to be secondary to a traumatic distal vagotomy. Neither gastric transection nor traumatic vagotomy had been reported previously in the pediatric population with abdominal seat-belt injuries. This report demonstrates an exceptionally rare seat-belt-related injury, and its unusual postoperative complication. It also emphasizes the significance of the "seat-belt sign" in the assessment of motor vehicle-related blunt abdominal trauma, and outlines potential problems associated with the wearing of adult-designed lap belts by pediatric passengers.

[Left diaphragmatic hernia due to blunt chest trauma complicated with intrapleural gastric perforation]

A 17-year-old male was injured by traffic accidents. Multiple left rib fractures, radiopacity of left hemithorax and rightward mediastinal shift lead us to the diagnosis of traumatic hemothorax. But left tube thoracostomy could not obtain any fluid. After this finding we suspected diaphragmatic hernia. Neither inserted nasogastric tube nor abdominal echogram could not lead to definitive diagnosis. Chest CT could identify stomach and spleen in the thoracic cavity. Insufflation of 300 ml air through nasogastric tube could not expand the stomach. By insertion of another thoracic tube some coffee-ground like materials could be obtained. Laparotomy disclosed rupture of left hemidiaphragm and intrathoracic displacement of the stomach and spleen. After reposition of stomach, we discovered 5 cm fissure of the stomach and left thoracic cavity filled with leaked gastric contents. Though reports of combined diaphragmatic hernia and gastric rupture are rare, these combination could occur if a patient with diaphragmatic hernia encounters blunt chest trauma on a full stomach.

Gastric perforation in the neonate: clinical analysis of 12 cases

Gastric perforation is a rare abdominal catastrophe which associated with high mortality in newborn infants. From June 1978 to July 1991, twelve cases of neonatal gastric perforation presented at Chang Gung Memorial Hospital. Male to female ratio was 9:3. The most common presenting signs were abdominal distension (100%), feeding intolerance (92%), respiratory distress (67%) and poor activity (58%). All cases had significant symptoms between two and five days of age. All of the abdominal plain film showed pneumoperitonium. The most common site of perforation was the great curvature of the stomach (83%). Among the 10 pathological reports available, 8 cases had ischemic change and 2 cases had hemorrhage and inflammatory cell infiltration. There was a high mortality rate of 58% in this series. Male, hyponatremia (serum sodium < 130 meq/l) and metabolic acidosis (pH < 7.3) were poor prognostic factors. This report suggests that early diagnosis and early management before clinical deterioration of the metabolic status may improve prognosis for neonatal gastric perforation patients.

[Stomach rupture after nasal oxygen therapy]

A 69-year-old male developed a spontaneous rupture of the normal stomach during oxygen administration via a nasopharyngeal catheter. The clinical picture and treatment is discussed.