Spontaneous gastric perforation in a term neonate: a case report and literature review

Introduction: Spontaneous neonatal gastric perforation is a rare surgical emergency, predominantly seen in preterm neonates. Its occurrence in term neonates with normal birth weight and without identifiable risk factors is uncommon. Delayed recognition is associated with high morbidity and mortality. Case Presentation: We report the case of a 4-day-old female term neonate with normal birth weight who developed progressive abdominal distension and non-bilious vomiting 2 days after admission to the neonatal intensive care unit for perinatal asphyxia and early-onset neonatal sepsis. Radiographic evaluation revealed free air under the right hemidiaphragm. Emergency laparotomy identified a small perforation on the anterior wall of the gastric body, which was successfully managed with primary repair. The postoperative course was uneventful. Discussion: The etiology of spontaneous gastric perforation in neonates remains controversial. Proposed mechanisms include gastric ischemia, congenital weakness of the gastric wall, and increased intragastric pressure. Prompt diagnosis and urgent surgical intervention are essential for improved outcomes. Conclusion: Gastric perforation can occur in term neonates with normal birth weight. Resuscitation with bag-and-mask ventilation and nasogastric tube insertion may represent potential risk factors. Early recognition and timely surgical intervention can result in favorable outcomes, even in low-resource settings.