Spontaneous Gastric Perforation Research Articles

Excisional biopsy of perforated gastric ulcer: mandatory or potentially harmful?

PurposeThis study aimed to evaluate the morbidity associated with excisional biopsy in patients with spontaneous gastric perforation.MethodsA retrospective, single-center, observational study was performed. All consecutive patients with spontaneous gastric perforation who underwent surgical therapy were included. Outcomes were assessed concerning the performance of excisional biopsy.ResultsA total of 135 adult patients were enrolled. Of these, 110 (81.5%) patients underwent excisional biopsy, while 17 (12.6%) did not. The remaining eight (5.9%) patients who underwent gastric resection were excluded from the analysis. Patients undergoing excisional biopsy developed significantly higher rates of postoperative complications (p = 0.007) and experienced more severe complications according to the Clavien-Dindo classification, particularly type III and above (p = 0.017). However, no significant differences were observed regarding in-hospital mortality, reoperation, suture dehiscence, or length of hospital stay.ConclusionExcisional biopsy for gastric perforation has been shown to be associated with increased morbidity. Surgical closure followed by early endoscopic biopsy may be a superior approach for gastric perforation management to rule out malignancy.

Gastric perforation biopsy: is it obsolete?

PurposeThe aim of the study was to test the established hypothesis that biopsies of spontaneous gastric perforations should be taken to rule out cancer.MethodsA prospective observational study was performed. Consecutive patients with spontaneous gastric perforation were included. Biopsies of the edges of the perforation were submitted for histological evaluation. The epithelial type as well as the nature of the pathology were evaluated.ResultsSixty-eight patients were included. Eight (12%) biopsies revealed duodenal origin. Sixty (88%) biopsies revealed gastric mucosa of which 33 (48%) could be specifically typed. All biopsies revealed benign ulceration. No malignancies were detected in these biopsies or on subsequent gastroscopic follow up.ConclusionThis study suggests that routine intraoperative biopsy of gastric perforation may be questioned. Biopsy is probably better performed endoscopically after recovery.

A Case Report of Spontaneous Gastric Perforation in Newborns

Spontaneous gastric perforation is a serious, rare and life threatening condition. Perforation of the stomach is a full thickness injury to the wall of the organ. As the peritoneum completely covers the stomach, perforation of the wall creates a communication between the gastric lumen and the peritoneal cavity. Gastric perforation is caused by three different mechanisms. We report a case of gastric perforation in a Preterm, very low birth weight neonate in our NICU and based on the signs of abdominal distension and increased abdominal girth. Abdomen ultrasonography and Contrast dye study was done which showed perforation, following which exploratory laparotomy was performed and surgical repair was carried out. As it has high mortality rate so its prompt recognition and surgical intervention is utmost necessary

S3100 An Unusual Cause of Spontaneous Gastric Perforation

S3100 An Unusual Cause of Spontaneous Gastric Perforation

A case of spontaneous gastric perforation in a 3 years old male child

A 3 years old boy attended emergency department with history of abdominal distension, fever, vomiting, loose stools for 5 days. The boy was suffering from epilepsy from last 1 year of age and was under treatment. From history and clinical examination, it seemed to be a case of peritonitis. Abdominal ultrasound revealed debrigenous free fluid in peritoneal cavity. Emergency exploratory laparotomy done and pyloric perforation was noted and repaired by modified graham’s patch. The child, post-operatively, suffered from dys-electrolytemia and wound site infection and recovered with treatment.

Spontaneous Gastric Perforation in a Child and Endoscopic Balloon Dilation for Postoperative Gastric Stenosis.

Spontaneous Gastric Perforation in a Child and Endoscopic Balloon Dilation for Postoperative Gastric Stenosis.

Spontaneous gastric perforation in a 3 year old male child – A case report

spontaneous gastric perforation in paediatric patients beyond the neonatal age is seldom to seen by paediatric surgeon. Therefore we are sharing this case with enlisting the previously reported similar cases in English literature. a three year old male child presented with abdominal distension and hypovolemic shock. Free gas under diaphragm was explained the perforation and exploration confirm the gastric perforation. spontaneous gastric perforation is extremely rare in paediatric age group beyond the neonatal age group, but incidence probability is always there. So, each laparotomy needed exploration of stomach also.

Orbital Lymphoma and Spontaneous Gastric Perforation, Rare and Fatal Complication

Orbital Lymphoma and Spontaneous Gastric Perforation, Rare and Fatal Complication

Spontaneous gastric perforation: is it really common?

BackgroundNeonatal gastric perforation (NGP) is a rare, serious, and life-threatening condition which needs early recognition with prompt intervention for better prognosis. Its etiology is not yet well established, but multiple speculations have been put forth for its etiopathogenesis. Few most considered are traumatic, spontaneous, or secondary to inflammatory process like necrotizing enterocolitis. This study describes the etiological and prognostic factors for patients with NGP in our experience at a single center.ResultsA total of 46 neonates were included. Male gender predominated with M:F being 1.7:1. Most (n=36) neonates presented within 10 days of life whereas 8 neonates presented within 15 days. At presentation, gas under diaphragm was the most common radiologic finding in 25 (54.3%) neonates. On exploratory laparotomy, it was found that greater curvature was involved in maximum number of cases (n=27), followed by lesser curvature and anterior and posterior walls of the stomach. Most of perforations were within 1–5 cm in size. Gastrorrhaphy was done in all cases, and in two cases, feeding jejunostomy was done along with repair for feeding purpose. Finally, spontaneous NGP was diagnosed in 30 (60.8%), and NEC patches on other parts of the intestine were seen in 11 patients. Postoperatively, 28 neonates developed complications in the form of sepsis (n=13), wound infection (n=10), and burst abdomen (n=5). Regarding clinical outcome, 27 (58.7%) were discharged from the hospital whereas 19 (39.3%) patients died.ConclusionOur results show that spontaneous NGP is most commonly associated with NEC in our population, usually affecting the greater curvature. We observed a high mortality rate; however, good ICU care may improve the survival.

Delayed laparotomy and gastric repair in gastric perforation: a case report in the neonatal patient

Background: The incidence of gastric perforation in neonates is rare but has a high mortality rate of 15-70%. Spontaneous gastric perforation in neonates is estimated to occur in one of 2,900 live births and accounts for approximately 7% of all gastrointestinal perforations in neonates and children.Case: We present a case of gastric perforation complicated by sepsis, anemia, thrombocytopenia, and hypoalbuminemia in a 3-day-old girl. The patient was brought to the emergency room of Dr. Soetomo Hospital Surabaya with blood vomiting complaints from 1 day. On physical examination, it was found that the general condition was weak, with an axillary temperature of 38.2° C. The abdomen looked distended from inspection of the abdominal region, with the dilated vein and periumbilical hyperemia. Its percussion revealed the loss of liver dullness. The results of laboratory examinations: Hb 10.7 g/dl, Platelet 14,000/mm3, Albumin 2,6 g/dl. Plain thoracoabdominal X-Ray study showed a pneumoperitoneum. Needle decompression was performed because there were signs of Abdominal Compartment Syndrome (ACS). After five days of optimization in the Intensive Care Unit, a laparotomy exploration and primary repair of gastric perforation were conducted.Conclusion: Gastric perforation in neonates is a rare condition. The management principle for each patient is different depending on the patient's condition. Needle decompression is indicated when ACS is present or the patient's condition is not optimal for surgery. Definitive laparotomy can be done after the patient's condition has been stabilized. Proper selection of treatment can improve the patient's outcome and reduce the risk of morbidity and mortality.

Successful Multiteam Approach for Massive Jejunoileal Bleeding 10 Years after Gastrectomy for Spontaneous Gastric Perforation in Neonate: A Case Report

Successful Multiteam Approach for Massive Jejunoileal Bleeding 10 Years after Gastrectomy for Spontaneous Gastric Perforation in Neonate: A Case Report

Gastrointestinal perforations in newborns with high mortality: A series of 18 cases

Gastrointestinal perforations (GIP) in newborns are serious neonatal conditions that have significant morbidity and mortality, especially in resource constrained setups. This study was done to describe our experience of GIP in neonates and identify the factors leading to high mortality in our setup. We collected 18 cases with GIP in neonates. The average age was 5.7 days (range, 1-7 days). The sex ratio was 0.64. The average time to treatment was 3.3 days (range, 1-10 days). The etiology of GIP was perforated necrotizing enterocolitis (13 patients), spontaneous gastric perforation (2 patients), perforated ileal atresia (1 patient), ileal perforation complicating a strangulated inguinoscrotal hernia (1 patient), and peritonitis after colostomy (1 patient). Mortality was 77.8% (n=14), among which 9 newborns (64.3%) died preoperatively. Prematurity, management delay, and lack of a neonatal intensive care unit were the main poor prognostic factors. Mortality from GIP is still high in our context due to several factors, especially prematurity, management delay, and lack of a neonatal intensive care unit.

Spontaneous Gastric Perforation in a Preterm Infant: A Case Report of Etiologies and Anesthetic Considerations

: Gastric rupture is responsible for 7% of all gastrointestinal perforations in neonates and has a poor outcome and it can be lethal. There are many situations such as prematurity, asphyxia, excessive respiratory resuscitations and other conditions leading to this condition. We introduce a 2-day-old premature neonate (male) with abdominal distension following nutrition and then we will discuss the anesthetic care for him.

Invasive primary gastric mucormycosis-associated gastric perforation in an immunocompetent host

Introduction: Mucormycosis is a rare opportunistic fungal infection associated with high morbidity and mortality. Immunocompromised hosts are most at risk. Primary gastric mucormycosis is rarely reported, with rhinocerebral and pulmomary being most common sites for infection. Objectives/Aims: Here we describe a case of spontaneous gastric perforation due to invasive primary gastric mucormycosis infection in an immunocompetent host. No approval of the institutional review committee was needed as this was in the course of common clinical practice. Methods: A 28-year-old male with depression and anxiety, and subdural hematoma three months prior was found down after seizure. On arrival he was haemodynamically unstable, admitted to the intensive care unit (ICU) for management of sepsis and multisystem organ dysfunction, and initiated on renal replacement. Further evaluation revealed viscous perforation and pneumoperitoneum. An emergent exploratory laparotomy was performed. Surgical exploration revealed a 10 cm perforated gastric ulcer on the superior portion of greater curvature with necrosis, and necrotic posterior and superior portions of the stomach measuring 5 cm and 7 cm, respectively. He underwent splenectomy, total gastrectomy and was left in discontinuity. Histopathology of gastric tissue confirmed mucormycosis. Results: Liposomal amphotericin 5 mg/kg of B daily was initiated following surgical intervention. He underwent multiple intraabdominal wash outs, liver biopsy and had additional cultures obtained. A jejunostomy was placed for nutritional support. He had an exploration of the left neck with cervical oesophagostomy. The patient was transitioned to isavuconazoium but due to concerns for malabsorption via jejunostomy micafungin was continued concurrently. He completed his course and responded appropriately, with plans for proposed anastomosis. Conclusion: Few cases of invasive gastric mucormycosis associated spontaneous gastric perforation have been reported. Furthermore, occurrence in an immunocompromised host is minimal. Rapid and aggressive identification and intervention are crucial for minimising morbidity and mortality associated with mucormycosis.

Spontaneous Gastric Perforation in Neonates: A Tertiary Pediatric Surgical Center Experience

Objective: To report our experience with spontaneous neonatal gastric perforation (SNGP) in a tertiary hospital over the last 9 years.Methods: Retrospective review of neonates with SNGP treated in Bristol Royal Hospital for Children between January 2010 and December 2018 was performed. Data retrieved included demography, perinatal clinical details, operative data, and outcome. Cases with esophageal atresia, necrotizing enterocolitis or distal obstruction were excluded.Results: Of 13 cases, 4 were males and 9 females. Two neonates were full term; while 11 were preterm with median gestational age of 28 weeks. Abdominal distension and metabolic acidosis were mostly found in these patients. Patent ductus arteriosus was encountered in 53.8% of the patients. The most common site of perforation was the greater curvature (38.4%) followed by posterior wall (30.8%) of the stomach. Primary repair was performed in all cases. One neonate developed recurrent perforation in the early postoperative period. Five preterm (38.5%) neonates succumbed in our series.Conclusion: SNGP is a rare condition increasingly diagnosed in preterm neonates. Greater curvature and posterior wall of stomach are commonly involved. Despite recent advances in intensive care, the prognosis is still poor in preterm babies with multiple associated problems.

P013 Spontaneous gastric perforation: a case report

P013 Spontaneous gastric perforation: a case report

A rare case of spontaneous gastric perforation in an adolescent

Incidence of Peptic ulcer perforation in children and adolescents are very rare. Perforated gastric ulcer is extremely rare with only handful of cases reported worldwide in the same age group. Pneumoperitoneum and peritonitis due to gastric perforation is a very rare presentation in children and adolescents and it can often be overlooked with disastrous consequences. Even though in young patients, peptic ulcerations can happen in association with H. pylori infection, secondary to medications like non-steroidal anti-inflammatory agents, corticosteroids, rarely due to Zollinger Ellison syndrome, related to stress, post burns or head trauma it is seldom common. Among perforations gastric perforation is very rare. Here we discuss a case of 15-year-old school student who presented with acute abdominal pain and features of peritonitis which we initially thought probably due to perforated appendix but turned out to be a gastric perforation. Plain radiograph of the abdomen showed pneumoperitoneum. When an emergency midline laparotomy was performed, we found a perforation in gastric antrum anteriorly with peritonitis which was treated by thorough decontamination and Graham's live omental patch closure. H. Pylori tests were negative. At a time when acute presentation of peptic ulcerations or perforation as its complication is decreasing in incidence worldwide, this case has come as an eye opener. Thus, perforated gastric/duodenal ulcer in pediatric and young adult patient should not be overlooked in a young patient presenting with acute abdomen. Many times, there is no clear etiology and then it is spontaneous perforation. Emergency surgical management is the preferred mode of treatment.

Gastric hepatoid adenocarcinoma resulting in a spontaneous gastric perforation: a case report and review of the literature

BackgroundGastric hepatoid adenocarcinoma (GHAC) is an atypical form of gastric cancer (GC) that has similar tissue morphology to hepatocellular carcinoma and frequently produces alpha-fetoprotein. We present an exceedingly rare case of GHAC resulting in a spontaneous gastric perforation.Case presentationA 61-year-old man presented at our institution complaining of abdominal and back pain. A computed tomography scan revealed a spontaneous gastric perforation with a solitary liver tumor and lymph node swelling. Following a diagnosis of advanced-stage GC with a gastric perforation, perforative peritonitis, multiple lymph node metastases, and a solitary metastasis of the lateral segment of the liver, the patient underwent distal gastrectomy. Histopathology of the resected specimen revealed that the tumor cells were arranged in a hepatoid pattern. On immunohistochemical staining, the tumor cells were positive for alpha-fetoprotein and Sal-like protein 4. Thus, the patient was diagnosed with GHAC. Hepatic resection of the solitary liver metastasis was performed. However, recurrence occurred and the patient achieved complete response following tegafur/gimeracil/oteracil-based chemotherapy.ConclusionsGHAC is a highly malignant histological subtype of GC. We reported on an extremely rare case of GHAC resulting in a spontaneous gastric perforation and reviewed the literature, including epidemiological data, treatment regimens, and the association between GHAC and alpha-fetoprotein-producing GC.

Rare case of gastric perforation with malrotation and volvulus: A case report

Gastric perforation in neonate has always been a catastrophe associated with high morbidity. The high mortality rate reflects to a certain extent the precariousness of the neonatal period, but the process evolves so rapidly that prompt diagnosis is necessary if improved survival rates are to be achieved. It is a mysterious entity regarding its cause, but three mechanisms; spontaneous perforation, trauma and ischemia are acceptable reasons for neonatal gastric perforation. Nonetheless, we present you here a rare case of malrotation with mid gut volvulus which presented with apparently spontaneous gastric perforation (1x1cm). Primary repair of the perforation with derotation of the volvulus was done. We question the spontaneity of neonatal gastric perforation and urge the need to look for the contributing cause.

Spontaneous Gastric Perforation in Two Adolescents.

Case seriesPatients: Female, 11 • Male, 15Final Diagnosis: Spontaneous gastric perforationSymptoms: Abdominal pain • distention • vomiting • leukocytosisMedication: —Clinical Procedure: Both patients had surgerySpecialty: GastroenterologyObjective:Rare etiologyBackground:Spontaneous gastric perforation is a rare clinical disorder. The majority of the available data have been reported in the neonatal age group. There are a few cases of spontaneous gastric perforation in preschool children. To our knowledge, there is no published information on spontaneous gastric perforation in older children and adolescents.Case Report:We describe the presentation and clinical course of two adolescent children who presented with spontaneous gastric perforation. Both children presented with acute onset abdominal pain, which progressively worsened. In both cases, the patient were taken urgently to the operating room after imaging studies had shown pneumoperitoneum. In both cases, surgery revealed gastric perforation with no obvious etiology, specifically no ulcer, inflammation, or other pathology.Conclusions:These two cases highlight the importance of including spontaneous gastric perforation, not just the typical duodenal/gastric ulcer, in the differential of a patient with severe abdominal pain and distension, who has imaging showing pneumoperitoneum.