# Neonatal total gastrectomy as treatment for gastric rupture: Case report

## TL;DR

A 2-day-old baby survived a rare and severe stomach rupture treated with total stomach removal and a special intestinal connection, showing the importance of careful post-surgery care.

## Contribution

This case report presents a rare neonatal total gastrectomy using a pouchless Roux-en-Y esophagojejunostomy for extensive gastric perforation.

## Key findings

- The patient survived and achieved adequate nutritional status 2.9 years post-surgery.
- Pouchless Roux-en-Y reconstruction was successfully used in this neonatal gastrectomy case.
- Barotrauma, prematurity, low weight, and gastric ischemia were identified as risk factors for gastric perforation.

## Abstract

Neonatal gastric perforation is an uncommon but life-threatening condition, rarely requiring gastrectomy. We report the case of a neonate requiring total gastrectomy secondary to suspected barotrauma leading to gastric perforation.

A 2-day-old term male was referred to our institution in extremis following attempted resuscitation with makeshift positive airway pressure ventilation in the setting of respiratory distress. Exam was notable for a distended, peritonitic abdomen, and abdominal radiograph showed massive pneumoperitoneum. Exploratory laparotomy revealed an extensive anterior gastric perforation extending from the pylorus to the esophagogastric junction, along with gross ischemia of the posterior gastric wall. The patient underwent gastrectomy with pouchless retrocolic Roux-en-Y esophagojejunostomy reconstruction. He was kept NPO (nil per os) on total parenteral nutrition for seven days. Esophagram on postoperative day 7 demonstrated patency of the esophagojejunal anastomosis without leaks, and he was transitioned to formula via nasojejunal tube feeds supplemented with vitamins and pancreatic enzymes. He was discharged home on postoperative day 45. At latest follow-up 2.9 years after surgery, his height and weight were in the 10th percentile for his age.

This report showcases the successful management of an extensive gastric perforation with gastrectomy and pouchless Roux-en-Y esophagojejunostomy. Multidisciplinary postoperative and outpatient care was essential to ensure a positive outcome.

Neonatal gastric perforation is a rare condition with high morbidity and mortality, particularly in those born prematurely or low birthweight. This patient suffered from an extensive gastric perforation secondary to suspected barotrauma, undergoing gastrectomy and esophagojejunostomy without a pouch, achieving adequate nutritional status for his age.

•Neonatal gastric perforation is a rare life-threatening condition.•Total gastrectomy in neonates is extremely rare.•Most of these reports performed a pouch esophagojejunostomy.•Risk factors are barotrauma, prematurity, low weight and gastric ischemia.•Patients with total gastrectomy are at an increased risk of severe nutritional deficiencies.

Neonatal gastric perforation is a rare life-threatening condition.

Total gastrectomy in neonates is extremely rare.

Most of these reports performed a pouch esophagojejunostomy.

Risk factors are barotrauma, prematurity, low weight and gastric ischemia.

Patients with total gastrectomy are at an increased risk of severe nutritional deficiencies.