A case of neonatal gastric perforation misdiagnosed as neonatal necrotizing enterocolitis: A literature review.
Yuyang Wang, Quan Wen, Xichun Song et al.
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Case in brief
A male infant born at 33 weeks and 5 days presented on day four of life with abdominal distension, feeding refusal, and no passage of flatus or stool. Ultrasound showed mild bowel-wall thickening, absent peristalsis, and ascites; radiography showed extensive free intraperitoneal air. NEC with gastrointestinal perforation was suspected, but emergency laparotomy found an approximately 1-cm perforation of the posterior stomach near the proximal greater curvature, without intestinal ischemia, necrosis, or malformation. The gastric defect was repaired. The infant recovered, resumed enteral feeding, and was in good general condition at one-month follow-up.
What made this case unusual
The presentation and ultrasound suggested NEC, but surgery localized the perforation to the stomach and found no intestinal disease. The case illustrates that pneumoperitoneum signals perforation but does not establish its site.
Diagnostic / clinical pearl
In a neonate with rapidly progressive abdominal distension and substantial pneumoperitoneum, consider gastric perforation even when imaging suggests NEC; free air alone cannot localize the defect.