A case of neonatal gastric perforation misdiagnosed as neonatal necrotizing enterocolitis: A literature review.
- 1Department of Pediatric Surgery, Tongliao People's Hospital, Tongliao, China.
- 2Department of Urology, Tongliao People's Hospital, Tongliao, China.
- 3Department of Surgery, Inner Mongolia Medical University, Hohhot, China.
Abstract
Rationale
Neonatal gastric perforation (NGP) is a rare but life-threatening neonatal acute abdominal condition. Its clinical and imaging manifestations may overlap with those of necrotizing enterocolitis (NEC), making accurate preoperative localization of the perforation site challenging. This case highlights the diagnostic challenges and key points in the differential diagnosis of NGP when its initial presentation resembles NEC.Patient concerns
A male infant born at 33 weeks and 5 days of gestation, with a birth weight of 2500 g, was admitted on the fourth day of life because of abdominal distension for 14 hours, feeding refusal, and cessation of flatus and stool passage.Diagnoses
Abdominal ultrasonography revealed mild bowel wall thickening, absent intestinal peristalsis, and ascites, while an upright abdominal radiograph showed a large amount of free air beneath both hemidiaphragms. Based on the infant's prematurity, abdominal distension, feeding refusal, and imaging findings, NEC complicated by gastrointestinal perforation was initially suspected. Emergency exploratory laparotomy revealed an approximately 1-cm perforation on the posterior gastric wall near the proximal greater curvature. No intestinal ischemia, necrosis, perforation, or gastrointestinal malformation was identified. The final diagnosis was NGP.Interventions
Immediately after admission, the infant received oxygen therapy, continuous monitoring, gastrointestinal decompression, anti-infective therapy, fluid replacement, and other supportive treatment. Emergency exploratory laparotomy, repair of the gastric perforation, peritoneal lavage, and drainage were subsequently performed. Postoperatively, respiratory support, gastrointestinal decompression, total parenteral nutrition, and other supportive treatments were provided.Outcomes
The infant recovered well after surgery, gradually resumed enteral feeding, and subsequently underwent successful removal of the gastric tube and abdominal drainage tube. At the 1-month follow-up, the infant was in good general condition and weighed 2.95 kg.Lessons
NGP should be considered in the differential diagnosis of neonates presenting with rapidly progressive abdominal distension and a large pneumoperitoneum, even when ultrasonographic findings suggest NEC. Pneumoperitoneum may indicate gastrointestinal perforation but cannot independently identify the site of perforation. In neonates whose clinical presentation is not entirely consistent with NEC or whose condition progresses rapidly, early surgical evaluation and, when necessary, timely exploratory surgery may help establish the diagnosis and facilitate targeted treatment.
Related
- From sepsis to necrotizing enterocolitis with appendiceal perforation: a case report of successful salvage therapy with aztreonam–avibactam in an extremely preterm infant with NDM-producing Klebsiella pneumoniae
- Maternal risk factors associated with neonatal necrotizing enterocolitis: a meta-analysis and systematic review.
- An ultrasound-based nomogram for predicting early neonatal necrotizing enterocolitis
- Necrotizing Enterocolitis Secondary to Congenital Syphilis in an 18-Day-Old Neonate: Successful Treatment With Intravenous Penicillin.
- Chronic appendiceal perforation leading to cecal–abdominal wall fistula long misdiagnosed as recurrent groin abscess: a rare case report
BibTeX
@article{wang2026case,
title = {{A case of neonatal gastric perforation misdiagnosed as neonatal necrotizing enterocolitis: A literature review.}},
author = {Yuyang Wang and Quan Wen and Xichun Song and Yunpeng Guo and Long Chen and Bo Chen and Gai Hang},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051231},
url = {https://europepmc.org/article/MED/42888617},
note = {CC BY},
}
RIS
TY - JOUR
TI - A case of neonatal gastric perforation misdiagnosed as neonatal necrotizing enterocolitis: A literature review.
AU - Yuyang Wang
AU - Quan Wen
AU - Xichun Song
AU - Yunpeng Guo
AU - Long Chen
AU - Bo Chen
AU - Gai Hang
PY - 2026
DA - 2026/10/01
JO - Medicine
DO - 10.1097/md.0000000000051231
UR - https://europepmc.org/article/MED/42888617
AB - Rationale Neonatal gastric perforation (NGP) is a rare but life-threatening neonatal acute abdominal condition. Its clinical and imaging manifestations may overlap with those of necrotizing enterocolitis (NEC), making accurate preoperative localization of the perforation site challenging. This case highlights the diagnostic challenges and key points in the differential diagnosis of NGP when its initial presentation resembles NEC.Patient concerns A male infant born at 33 weeks and 5 days of gestation, with a birth weight of 2500 g, was admitted on the fourth day of life because of abdominal distension for 14 hours, feeding refusal, and cessation of flatus and stool passage.Diagnoses Abdominal ultrasonography revealed mild bowel wall thickening, absent intestinal peristalsis, and ascites, while an upright abdominal radiograph showed a large amount of free air beneath both hemidiaphragms. Based on the infant's prematurity, abdominal distension, feeding refusal, and imaging findings, NEC complicated by gastrointestinal perforation was initially suspected. Emergency exploratory laparotomy revealed an approximately 1-cm perforation on the posterior gastric wall near the proximal greater curvature. No intestinal ischemia, necrosis, perforation, or gastrointestinal malformation was identified. The final diagnosis was NGP.Interventions Immediately after admission, the infant received oxygen therapy, continuous monitoring, gastrointestinal decompression, anti-infective therapy, fluid replacement, and other supportive treatment. Emergency exploratory laparotomy, repair of the gastric perforation, peritoneal lavage, and drainage were subsequently performed. Postoperatively, respiratory support, gastrointestinal decompression, total parenteral nutrition, and other supportive treatments were provided.Outcomes The infant recovered well after surgery, gradually resumed enteral feeding, and subsequently underwent successful removal of the gastric tube and abdominal drainage tube. At the 1-month follow-up, the infant was in good general condition and weighed 2.95 kg.Lessons NGP should be considered in the differential diagnosis of neonates presenting with rapidly progressive abdominal distension and a large pneumoperitoneum, even when ultrasonographic findings suggest NEC. Pneumoperitoneum may indicate gastrointestinal perforation but cannot independently identify the site of perforation. In neonates whose clinical presentation is not entirely consistent with NEC or whose condition progresses rapidly, early surgical evaluation and, when necessary, timely exploratory surgery may help establish the diagnosis and facilitate targeted treatment.
SN - 0304-5412
SN - 1536-5964
ER -