Gastric perforation

Gastric perforation in the neonatal period is rare, however it

continues to be associated with significant morbidity and

mortality. Spontaneous neonatal gastric perforation is esti-

mated to occur in one in 2900 live births1 and accounts for

approximately 1015% of all gastrointestinal perforations in neonates and children (Table 47.1). Gastrointestinal perfora-

tions occur more commonly in males, however there appears

to be no sex predilection for those occurring in the

stomach.24 Recent series may suggest a male predominance,

but this remains inconclusive.57 The terminology used to

describe neonatal gastric perforation has been inconsistent

and its etiology remains a topic of debate. Spontaneous or

idiopathic gastric perforations refer to those with no

identifiable underlying cause and account for the majority

of gastric perforations in most reported series.1,3,513 Never-

theless, many pediatric surgeons believe that an underlying

cause can be found in most cases of neonatal gastric

Siebold, in 1926, is credited with the first description of a

gastrointestinal perforation with no demonstrable cause, the

so-named spontaneous perforation.15 In 1929, Stern et al.16

reported attempts at surgical repair. Agerty et al.17 reported

the first successful repair of a neonatal intestinal (ileum)

perforation in 1943 and Leger et al.,18 in 1950, described the

first successful repair of a neonatal gastric perforation.

Survival following a neonatal gastric perforation was rare

prior to the 1960s. While mortality has improved since that

time it remains significant and ranges from 25 to over 50% in

most series.1,2,47,14,19,20