Gastric Perforation

  • Adam C. Alder
  • Robert K. MinkesEmail author
Reference work entry


Neonatal gastric perforation is rare and life-threatening condition period and can be associated with overdistension, gastric intubation, ischemia, or idiopathic causes. Infants with this complication have a high mortality (25–50%). Typically there is a constellation of symptoms which can help identify this condition. These symptoms include fever, sepsis, abdominal distension, hematemesis, pneumoperitoneum, and respiratory failure. Recognition of the symptoms allows preoperative preparation including endotracheal intubation for respiratory failure, volume resuscitation, administration of antibiotics, and possible abdominal decompression. Traditional operative approaches and laparoscopy have been employed to correct this abnormality. Operative principles include control of spillage, debridement of devitalized tissue, and multiple repair techniques. Future investigation includes improvements in the understanding of the underlying causes of idiopathic and spontaneous perforation, improvement in prevention of the perforations of known cause, and advancement of repair techniques and approaches.


Gastric perforation Pneumoperitoneum Stomach Trauma Ischemia 


  1. Agerty HA, Ziserman A, Schollenberger CL. A case of perforation of the ileum in a newborn infant with operation and recovery. J Pediatr. 1943;22:233–8.Google Scholar
  2. Alonso-Vanegas M, Alvarez JL, Delgado L, Mendizabal R, Jimenez JL, Sanchez-Cabrera JM. Gastric perforation due to ventriculo-peritoneal shunt. Pediatr Neurosurg. 1994;21(3):192–4.PubMedCrossRefPubMedCentralGoogle Scholar
  3. Aslan Y, Sarihan H, Dinc H, Gedik Y, Aksoy A, Dereci S. Gastric perforation presenting as bilateral scrotal pneumatoceles. Turk J Pediatr. 1999;41(2):267–71.PubMedPubMedCentralGoogle Scholar
  4. Aydin M, Zenciroglu A, Hakan N, Erdogan D, Okumus N, Ipek MS. Gastric perforation in an extremely low birth weight infant recovered with percutaneous peritoneal drainage. Turk J Pediatr. 2011;53(4):467–70.PubMedPubMedCentralGoogle Scholar
  5. Aydin M, Deveci U, Taskin E, Bakal U, Kilic M. Percutaneous peritoneal drainage in isolated neonatal gastricperforation. World J Gastroenterol. 2015;21(45):12987–8.PubMedPubMedCentralCrossRefGoogle Scholar
  6. Bell MJ. Perforation of the gastrointestinal tract and peritonitis in the neonate. Surg Gynecol Obstet. 1985;160(1):20–6.PubMedPubMedCentralGoogle Scholar
  7. Bilik R, Freud N, Sheinfeld T, et al. Subtotal gastrectomy in infancy for perforating necrotizing gastritis. J Pediatr Surg. 1990;25(12):1244–5.PubMedCrossRefPubMedCentralGoogle Scholar
  8. Bloom BT, Delmore P, Park YI, Nelson RA. Respiratory distress syndrome and tracheoesophageal fistula: management with high-frequency ventilation. Crit Care Med. 1990;18(4):447–8.PubMedCrossRefPubMedCentralGoogle Scholar
  9. Braunstein H. Congenital defect of the gastric musculature with spontaneous perforation; report of five cases. J Pediatr. 1954;44(1):55–63.PubMedCrossRefPubMedCentralGoogle Scholar
  10. Burnett HA, Halpert B. Perforation of the stomach of a newborn infant with pyloric atresia. Arch Pathol. 1947;44(3):318–20.Google Scholar
  11. Bush CM, Jones JS, Cohle SD, Johnson H. Pediatric injuries from cardiopulmonary resuscitation. Ann Emerg Med. 1996;28(1):40–4.PubMedCrossRefPubMedCentralGoogle Scholar
  12. Chen TY, Liu HK, Yan MC, et al. Neonatal gastric perforation: a report of two cases and a systematic review. Medicine (Baltimore). 2018; 97(17): e0369.PubMedPubMedCentralCrossRefGoogle Scholar
  13. Christoph CL, Poole CA, Kochan PS. Operative gastric perforation: a rare complication of ventriculoperitoneal shunt. Pediatr Radiol. 1995;25(Suppl 1):S173–4.PubMedPubMedCentralGoogle Scholar
  14. Custer JR, Polley Jr TZ, Moler F. Gastric perforation following cardiopulmonary resuscitation in a child: report of a case and review of the literature. Pediatr Emerg Care. 1987;3(1):24–7.PubMedCrossRefPubMedCentralGoogle Scholar
  15. Duran R, Inan M, Vatansever U, Aladag N, Acunas B. Etiology of neonatal gastric perforations: review of 10 years’ experience. Pediatr Int: Off J Jpn Pediatr Soc. 2007;49(5):626–30.CrossRefGoogle Scholar
  16. Gluer S, Schmidt AI, Jesch NK, Ure BM. Laparoscopic repair of neonatal gastric perforation. J Pediatr Surg. 2006;41(1):e57–8.PubMedCrossRefPubMedCentralGoogle Scholar
  17. Graivier L, Rundell K, McWilliams N, Carruth D. Neonatal gastric perforation and necrosis: ninety-five percent gastrectomy and colonic interposition, with survival. Ann Surg. 1973;177(4):428–31.PubMedPubMedCentralCrossRefGoogle Scholar
  18. Gray PH, Pemberton PJ. Gastric perforation associated with indomethacin therapy in a pre-term infant. Aust Paediatr J. 1980;16(1):65–6.PubMedPubMedCentralGoogle Scholar
  19. Grosfeld JL, Molinari F, Chaet M, et al. Gastrointestinal perforation and peritonitis in infants and children: experience with 179 cases over ten years. Surgery. 1996;120(4):650–5; discussion 5–6.PubMedCrossRefPubMedCentralGoogle Scholar
  20. Halvax P, Diana M, Legner A, et al. Endoluminal full-thickness suture repair of gastrotomy: a survival study. Surg Endosc. 2015.Google Scholar
  21. Holcomb 3rd GW. Survival after gastrointestinal perforation from esophageal atresia and tracheoesophageal fistula. J Pediatr Surg. 1993;28(12):1532–5.PubMedCrossRefPubMedCentralGoogle Scholar
  22. Holgersen LO. The etiology of spontaneous gastric perforation of the newborn: a reevaluation. J Pediatr Surg. 1981;16(4 Suppl 1):608–13.PubMedCrossRefPubMedCentralGoogle Scholar
  23. Houck Jr WS, Griffin 3rd JA. Spontaneous linear tears of the stomach in the newborn infant. Ann Surg. 1981;193(6):763–8.PubMedPubMedCentralCrossRefGoogle Scholar
  24. Im SA, Lim GY, Hahn ST. Spontaneous gastric perforation in a neonate presenting with massive hydroperitoneum. Pediatr Radiol. 2005;35(12):1212–4.PubMedCrossRefPubMedCentralGoogle Scholar
  25. Jactel SN, Abramowsky CR, Schniederjan M, et al. Noniatrogenic neonatal gastric perforation: the role of interstitial cells of Cajal. Fetal Pediatr Pathol. 2013;32(6):422–8.PubMedCrossRefPubMedCentralGoogle Scholar
  26. Jawad AJ, Al-Rabie A, Hadi A, et al. Spontaneous neonatal gastric perforation. Pediatr Surg Int. 2002;18(5–6):396–9.PubMedCrossRefPubMedCentralGoogle Scholar
  27. Kara CS, Ilce Z, Celayir S, Sarimurat N, Erdogan E, Yeker D. Neonatal gastric perforation: review of 23 years’ experience. Surg Today. 2004;34(3):243–5.PubMedCrossRefPubMedCentralGoogle Scholar
  28. Leger JL, Ricard PM, Leonard C, Piette J. Perforated gastric ulcer in a newborn with survival. L’Union Medicale du Canada. 1950;79(11):1277–80.PubMedPubMedCentralGoogle Scholar
  29. Leone Jr RJ, Krasna IH. ‘Spontaneous’ neonatal gastric perforation: is it really spontaneous? J Pediatr Surg. 2000;35(7):1066–9.PubMedCrossRefPubMedCentralGoogle Scholar
  30. Maekawa S, Nomura R, Murase T, Ann Y, Harada M. Complete closure of artificial gastric ulcer after endoscopic submucosal dissection by combined use of a single over-the-scope clip and through-the-scope clips (with videos). Surg Endosc. 2015;29(2):500–4.PubMedCrossRefPubMedCentralGoogle Scholar
  31. Maoate K, Myers NA, Beasley SW. Gastric perforation in infants with oesophageal atresia and distal tracheo-oesophageal fistula. Pediatr Surg Int. 1999;15(1):24–7.PubMedCrossRefPubMedCentralGoogle Scholar
  32. Miller FA. Neonatal gastrointestinal tract perforations. J Lancet. 1957;77(11):439–42.PubMedPubMedCentralGoogle Scholar
  33. Ohshiro K, Yamataka A, Kobayashi H, et al. Idiopathic gastric perforation in neonates and abnormal distribution of intestinal pacemaker cells. J Pediatr Surg. 2000;35(5):673–6.PubMedCrossRefPubMedCentralGoogle Scholar
  34. O’Neil EA, Chwals WJ, O’Shea MD, Turner CS. Dexamethasone treatment during ventilator dependency: possible life threatening gastrointestinal complications. Arch Dis Child. 1992;67(1 Spec No):10–1.PubMedPubMedCentralCrossRefGoogle Scholar
  35. Othersen Jr HB, Gregorie Jr HB. Pneumatic rupture of the stomach in a newborn infant with esophageal atresia and tracheoesophageal fistula. Surgery. 1963;53:362–7.PubMedPubMedCentralGoogle Scholar
  36. Pelizzo G, Dubois R, Lapillonne A, et al. Gastric necrosis in newborns: a report of 11 cases. Pediatr Surg Int. 1998;13(5–6):346–9.PubMedCrossRefPubMedCentralGoogle Scholar
  37. Pochaczevsky R, Bryk D. New roentgenographic signs of neonatal gastric perforation. Radiology. 1972;102(1):145–7.PubMedCrossRefPubMedCentralGoogle Scholar
  38. Rajadurai VS, Yu VY. Intravenous indomethacin therapy in preterm neonates with patent ductus arteriosus. J Paediatr Child Health. 1991;27(6):370–5.PubMedCrossRefPubMedCentralGoogle Scholar
  39. Reyes HM, Meller JL, Loeff D. Management of esophageal atresia and tracheoesophageal fistula. Clin Perinatol. 1989;16(1):79–84.PubMedCrossRefPubMedCentralGoogle Scholar
  40. Rosser SB, Clark CH, Elechi EN. Spontaneous neonatal gastric perforation. J Pediatr Surg. 1982;17(4):390–4.PubMedCrossRefPubMedCentralGoogle Scholar
  41. Sato M, Hamada Y, Kohno M, et al. Neonatal gastrointestinal perforation in Japan: a nationwide survey. Pediatr Surg Int. 2017; 33(1): 33–41.PubMedCrossRefPubMedCentralGoogle Scholar
  42. Shaw A, Blanc WA, Santulli TV, Kaiser G. Spontaneous rupture of the stomach in the newborn: a clinical and experimental study. Surgery. 1965;58:561–71.PubMedPubMedCentralGoogle Scholar
  43. Siebold AE. Brand in der kleinen kurvatier des magens eines atrophischen kindes. J Geburtsch Frauenzimmer Kinderk. 1826;5:3–4.Google Scholar
  44. Silbergleit A, Berkas EM. Neonatal gastric rupture. Minn Med. 1966;49(1):65–8.PubMedPubMedCentralGoogle Scholar
  45. Stern MA, Perkins E, Nessa N. Perforated gastric ulcer in a 2-day-old infant. Lancet. 1929;49:492–4.Google Scholar
  46. St-Vil D, LeBouthillier G, Luks FI, Bensoussan AL, Blanchard H, Youssef S. Neonatal gastrointestinal perforations. J Pediatr Surg. 1992;27(10):1340–2.PubMedCrossRefPubMedCentralGoogle Scholar
  47. Tan CE, Kiely EM, Agrawal M, Brereton RJ, Spitz L. Neonatal gastrointestinal perforation. J Pediatr Surg. 1989;24(9):888–92.PubMedCrossRefPubMedCentralGoogle Scholar
  48. Terui K, Iwai J, Yamada S, et al. Etiology of neonatal gastric perforation: a review of 20 years’ experience. Pediatr Surg Int. 2012;28(1):9–14.PubMedCrossRefPubMedCentralGoogle Scholar
  49. Touloukian RJ. Gastric ischemia: the primary factor in neonatal perforation. Clin Pediatr. 1973;12(4):219–25.CrossRefGoogle Scholar
  50. Waltsad PM, Conklin W. Rupture of the normal stomach after oxygen administration. New Engl J Med. 1961;264:1201–2.CrossRefGoogle Scholar
  51. Woo J, Eusterbrock T, Kim S. Intrauterine gastric perforation. Pediatr Surg Int. 2006;22(10):829–31.PubMedCrossRefPubMedCentralGoogle Scholar
  52. Yamataka A, Yamataka T, Kobayashi H, Sueyoshi N, Miyano T. Lack of C-KIT+ mast cells and the development of idiopathic gastric perforation in neonates. J Pediatr Surg. 1999;34(1):34–7; discussion 7–8.PubMedCrossRefPubMedCentralGoogle Scholar
  53. Yang CY, Lien R, Fu RH, et al. Prognostic factors and concomitant anomalies in neonatal gastricperforation. J Pediatr Surg. 2015;50(8):1278–82.PubMedCrossRefPubMedCentralGoogle Scholar
  54. Yang T, Huang Y, Li J, et al. Neonatal Gastric Perforation: Case series and Literature Review. World J Surg. 2018; 42(8): 2668–2673.PubMedCrossRefPubMedCentralGoogle Scholar
  55. Zamir O, Hadary A, Goldberg M, Nissan S. Spontaneous perforation of the stomach in the neonate. Z Kinderchir. 1987;42(1):43–5.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Division of Pediatric Surgery, Children’s Medical Center - Plano, Center for Pectus and Chest Wall Anomalies, Division of Pediatric Surgery, Children’s Health, Department of SurgeryUTSWDallasUSA
  2. 2.Division of Pediatric SurgeryGolisano Children’s Hospital Lee HealthFort MyersUSA

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