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Neonatal gastric rupture presenting with subcutaneous emphysema
CASE REPORTS
Neonatal Gastric Rupture Presenting With Subcutaneous Emphysema By Theodore
lancu, M.D., Yehuda
El-Dror,
Petach-Tikvah,
M.D., and Moshe
Kahn, M.D.
Israel
A 3300-g male was delivered precipitousIy after 12 hr of labor. Thirty minutes later he became apneic and deeply cyanotic. Spontaneous breathing reappeared after gentle thoracic compression; no tracheal intubation was performed. It was then noted that the abdomen was protruding and the scrotum extremely swollen (Fig. I). Subcutaneous emphysema was palpated over the trunk up to the axillary region. Abdominal X-rays showed subcutaneous emphysema, free air in the peritoneal cavity, and absence of gastric air with normal air content in the intestine. The absence of gastric air strongly suggested the stomach as the sit of perforation (Fig. 2). A nasogastric tube was placed and Iaparotomy performed 2% hr after birth. A 5-cm linear tear was found on the anterior gastric wall and was closed. The scrotum was deflated by needle puncture. Postoperative nasogastric drainage was continued for 48 hr, after which oral feedings were begun cautiously and the postoperative course thereafter was uneventful. Subcutaneous emphysema has been reported in two patients.1 It is postulated that minute ruptures in the parietal peritoneum occur during a precipitous and traumatic birth; this may be the cause of some gastric perforation and could explain the subcutaneous emphysema. The episode of apnea and cyanosis probably was a consequence of sudden and massive pneumoperitoneum. Lloyd’s suggestion 2 of perinatal asphyxia as a predisposing cause probably does not apply in our patient since his reported range of onset of symptoms is 12 hr to 5 days after an episode of asphyxia. Early recognition and treatment of the condition is of utmost importance in reducing the mortality rate.
Fig. 1. Patient’s scrotum at age 1 hr. There was no evidence of liquid at transillumination and subcutaneous emphysema was palpated over the entire abdomen and scrotum.
Fig. 2. Tension pneumoperitoneum and subcutaneous emphysema evident on upright roentgenogram. Note absence of the gastric air bubble. REFERENCES 1. Livaditis, A., and Okmian, L.: Gastric perforation in the neonate. Acta Paediat. (Stockh.) 52:595, 1963.
2. Lloyd, J. R.: The etiology of gastrointestinal perforations in the newborn. J. Pediat. Surg. 4:77, 1969.
Neonatal Gastric Rupture Presenting With Subcutaneous Emphysema By Theodore
lancu, M.D., Yehuda
El-Dror,
Petach-Tikvah,
M.D., and Moshe
Kahn, M.D.
Israel
A 3300-g male was delivered precipitousIy after 12 hr of labor. Thirty minutes later he became apneic and deeply cyanotic. Spontaneous breathing reappeared after gentle thoracic compression; no tracheal intubation was performed. It was then noted that the abdomen was protruding and the scrotum extremely swollen (Fig. I). Subcutaneous emphysema was palpated over the trunk up to the axillary region. Abdominal X-rays showed subcutaneous emphysema, free air in the peritoneal cavity, and absence of gastric air with normal air content in the intestine. The absence of gastric air strongly suggested the stomach as the sit of perforation (Fig. 2). A nasogastric tube was placed and Iaparotomy performed 2% hr after birth. A 5-cm linear tear was found on the anterior gastric wall and was closed. The scrotum was deflated by needle puncture. Postoperative nasogastric drainage was continued for 48 hr, after which oral feedings were begun cautiously and the postoperative course thereafter was uneventful. Subcutaneous emphysema has been reported in two patients.1 It is postulated that minute ruptures in the parietal peritoneum occur during a precipitous and traumatic birth; this may be the cause of some gastric perforation and could explain the subcutaneous emphysema. The episode of apnea and cyanosis probably was a consequence of sudden and massive pneumoperitoneum. Lloyd’s suggestion 2 of perinatal asphyxia as a predisposing cause probably does not apply in our patient since his reported range of onset of symptoms is 12 hr to 5 days after an episode of asphyxia. Early recognition and treatment of the condition is of utmost importance in reducing the mortality rate.
Fig. 1. Patient’s scrotum at age 1 hr. There was no evidence of liquid at transillumination and subcutaneous emphysema was palpated over the entire abdomen and scrotum.
Fig. 2. Tension pneumoperitoneum and subcutaneous emphysema evident on upright roentgenogram. Note absence of the gastric air bubble. REFERENCES 1. Livaditis, A., and Okmian, L.: Gastric perforation in the neonate. Acta Paediat. (Stockh.) 52:595, 1963.
2. Lloyd, J. R.: The etiology of gastrointestinal perforations in the newborn. J. Pediat. Surg. 4:77, 1969.