Neonatal gastric perforation

Abstract

Case report. A baby born by mid forceps after prolonged labour became seriously ill on the 3rd day and died the following day. At post mortem the abnormal findings were localised to the abdomen. The stomach was dilated to about 3 times the normal size. There was an oval perforation, measuring 4.0 x 3.0 cm along the greater curvature. The upper limit of the perforation was at the level of the junction of the fundus and the body of the stomach. The margin of the perforation was serrated and formed only by thinned out mucosa, the muscular layer having retracted around it. The adjacent mucosa was congested, haemorrhagic and showed small circular erosions, near the greater curvature. There was still a large quantity of curded milk in the stomach, and this was seen issuing through the rent, and scattered on to loops of small intestine, lying close to the stomach, and the upper, left paracolic gutter. There was peritonitis in the vicinity of the spilt materials. Histology of the perforation showed congestion and an acute inflammatory exudate containing bacteria, in the serosa close to the perforation. There were no defects in the muscularis. A second case had a more or less similar course clinically and at post mortem. The significance of septicaemia and trauma is discussed and relevant literature is reviewed.