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Peer-reviewedCC BY-NC-ND 4.0International Journal of Surgery Case Reports

Nasogastric tube–induced gastric perforation revealing incidental congenital intestinal malrotation in a term neonate: a case report from a resource-limited setting

  • Mathayo Shadrack1,2,3
  • Ahmed Ali Shabhay3,4
  • Nasib Daud Msuya1,2
  • Mwombeki Laetus1,2
  • Evelyne Neema Assenga1,5,6
  • Victor Ngotta1,2,5
6 affiliations
  1. 1Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
  2. 2Department of Surgery, Pediatric Surgery Unit, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
  3. 3Department of Pediatric Surgery, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Kilimanjaro, Tanzania
  4. 4Lugalo General Military Hospital, Dar es Salaam, Tanzania
  5. 5Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania
  6. 6Department of Pediatric and Neonatology, Muhimbili National Hospital (MNH), Dar es salaam, Tanzania
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Abstract

Background:: Neonatal gastric perforation (NGP) is a rare but life-threatening surgical emergency that usually affects preterm or critically ill neonates. Nasogastric tube (NGT)-induced perforation in term neonates is exceptionally uncommon. Coexisting congenital intestinal malrotation further increases diagnostic and operative complexity, especially in resource-limited settings.

Case presentation:: We report on a 6-day-old term male neonate weighing 2.5 kg who initially passed meconium and tolerated breastfeeding. On day 4 of life, he developed failure to pass stool, intermittent vomiting, and progressive abdominal distension. An NGT was inserted at a peripheral hospital for decompression. Two days later, worsening bilious vomiting, abdominal distension, and lethargy prompted referral. Laboratory investigations showed mild leukocytosis. Abdominal radiography demonstrated diffuse abdominal opacification and multiple air-fluid levels without definite pneumoperitoneum. An emergency exploratory laparotomy revealed gross peritoneal contamination and a 4 cm gastric perforation along the greater curvature, with the NGT exposed within the peritoneal cavity. Incidental congenital intestinal malrotation without volvulus was also identified. Primary gastric repair and peritoneal lavage were performed, while formal Ladd’s procedure was deferred because no obstructing Ladd’s bands were present. The neonate recovered well without postoperative complications over a 30-day follow-up period.

Discussion:: NGT-induced gastric perforation in term neonates is extremely rare and may present with nonspecific clinical and radiological findings, delaying diagnosis and treatment. Incidental malrotation represents an additional surgical consideration requiring close postoperative surveillance. Absence of pneumoperitoneum on radiography should not entirely exclude gastrointestinal perforation in symptomatic neonates.

Conclusion:: Early recognition, careful NGT monitoring, and prompt surgical intervention are essential for favorable outcomes in NGP.

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Cite

BibTeXRIS
BibTeX
@article{shadrack2026nasogastric,
  title = {{Nasogastric tube–induced gastric perforation revealing incidental congenital intestinal malrotation in a term neonate: a case report from a resource-limited setting}},
  author = {Mathayo Shadrack and Ahmed Ali Shabhay and Nasib Daud Msuya and Mwombeki Laetus and Evelyne Neema Assenga and Victor Ngotta},
  journal = {International Journal of Surgery Case Reports},
  year = {2026},
  month = oct,
  doi = {10.1097/rc9.0000000000001181},
  url = {https://doi.org/10.1097/rc9.0000000000001181},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Nasogastric tube–induced gastric perforation revealing incidental congenital intestinal malrotation in a term neonate: a case report from a resource-limited setting
AU  - Mathayo Shadrack
AU  - Ahmed Ali Shabhay
AU  - Nasib Daud Msuya
AU  - Mwombeki Laetus
AU  - Evelyne Neema Assenga
AU  - Victor Ngotta
PY  - 2026
DA  - 2026/10/22
JO  - International Journal of Surgery Case Reports
DO  - 10.1097/rc9.0000000000001181
UR  - https://doi.org/10.1097/rc9.0000000000001181
AB  - Background:: Neonatal gastric perforation (NGP) is a rare but life-threatening surgical emergency that usually affects preterm or critically ill neonates. Nasogastric tube (NGT)-induced perforation in term neonates is exceptionally uncommon. Coexisting congenital intestinal malrotation further increases diagnostic and operative complexity, especially in resource-limited settings.  Case presentation:: We report on a 6-day-old term male neonate weighing 2.5 kg who initially passed meconium and tolerated breastfeeding. On day 4 of life, he developed failure to pass stool, intermittent vomiting, and progressive abdominal distension. An NGT was inserted at a peripheral hospital for decompression. Two days later, worsening bilious vomiting, abdominal distension, and lethargy prompted referral. Laboratory investigations showed mild leukocytosis. Abdominal radiography demonstrated diffuse abdominal opacification and multiple air-fluid levels without definite pneumoperitoneum. An emergency exploratory laparotomy revealed gross peritoneal contamination and a 4 cm gastric perforation along the greater curvature, with the NGT exposed within the peritoneal cavity. Incidental congenital intestinal malrotation without volvulus was also identified. Primary gastric repair and peritoneal lavage were performed, while formal Ladd’s procedure was deferred because no obstructing Ladd’s bands were present. The neonate recovered well without postoperative complications over a 30-day follow-up period.  Discussion:: NGT-induced gastric perforation in term neonates is extremely rare and may present with nonspecific clinical and radiological findings, delaying diagnosis and treatment. Incidental malrotation represents an additional surgical consideration requiring close postoperative surveillance. Absence of pneumoperitoneum on radiography should not entirely exclude gastrointestinal perforation in symptomatic neonates.  Conclusion:: Early recognition, careful NGT monitoring, and prompt surgical intervention are essential for favorable outcomes in NGP.
SN  - 2210-2612
ER  -