Spontaneous Gastric Perforation in an Adolescent with Severe Motor and Intellectual Disabilities: A Case Report

抄録

Spontaneous gastric perforations are rare in adolescents. Here, we report the case of a 15-year-old boy with severe motor and intellectual disabilities (SMID) who was diagnosed with spontaneous gastric perforation. Due to his original condition and poor peristalsis caused by antiepileptic drugs, gas formation in the stomach and intestines was severe since infancy. After a femoral fracture at the age of 14 years and 5 months, the patient experienced reduced food intake and weight. He transferred to our hospital with shock vital due to severe peritonitis caused by gastric perforation. Immediately, he underwent an emergency laparotomy and partially resected with margins at the site of gastric perforation at the age of 15 years and 1 month. The cause of the gastric perforation was not identified by pathology. Intraoperative ascites culture detected Candida albicans. He was administered a long-term antifungal treatment for enteric mycosis with high β-D-glucan levels. Two months after the surgery, he was discharged. The detailed mechanism of gastric perforation is unclear but increased lumen pressure in the gastrointestinal tract has generally been speculated. In our case, we considered that the gastric perforation was caused by intestinal immunocompromise with Candida albicans overgrowth, associated with increased lumen pressure owing to the transverse position of the stomach. Therefore, deflation using gastrostomy may have been effective in relieving excess luminal pressure. Adequate nutritional evaluation and gastrostomy should be considered in patients with SMID, who have massive intestinal gas formation and gastric bubbles.