A Rare Case of Gastric Perforation Accompanying Intussusception in a Very Low-Birth Weight Infant

Abstract

A 729g boy was born at 25 weeks and 4 days' gestation by emergency caesarean section because of fetal distress. This infant showed a failure to pass meconium. On day 4, the infant presented with a sudden gross distention of the abdomen. Abdominal X-ray examination showed a massive pneumoperitoneum. An emergency operation was performed in accordance with a preoperative diagnosis of gastrointestinal perforation. At laparotomy, a perforation point was identified on the anterior surface of the lesser curvature of the stomach and ileo-ileal intussusception was found incidentally. After gastrorrhaphy, the intussusception lesion was resected and a primary anastomosis was completed. The postoperative course was complicated with an ileal anastomotic leakage, which resolved after reoperation. Thereafter he recovered uneventfully and was discharged in the seventh month of life. In the present case, it might be indicated that several interesting factors associated with ischemic change and increased intragastric pressure caused by the uncoordination of the gastroesophageal motility and mechanical ventilation induced the perforation of the gastric wall.