A Case of Neonatal Gastric Rupture Associated With Midgut Volvulus

Abstract

We report a case of neonatal gastric rupture with midgut volvulus. A male infant aged 5 days after birth was referred to our hospital owing to severe abdominal distention and bilious vomiting. He was delivered vaginally with a body weight of 2,480 g and gestation of 38 weeks. His Apgar score was 9/10. Before birth, no abnormality was observed. Nonbilious vomiting started on the 3rd day, and bilious vomiting and marked abdominal distention were observed on the 5th day; thus, he was brought to our Neonatal Intensive Care Unit. On admission, he exhibited severe abdominal distention and a pale complexion. Abdominal X-ray showed a saddle bag sign, which was diagnosed as gastric rupture. Emergency operation was performed following a large-volume infusion. During the operation, a large amount of white-yellowish ascites was encountered, and a 10 mm large rupture was found in the upper major curvature of the stomach. After the removal of necrotic tissue, the defect was sutured and closed. Further inspection revealed midgut volvulus; therefore, Ladd operation was carried out. Although sepsis and DIC developed postoperatively, he was able to survive. In this patient, it seemed that the increase in intragastric pressure induced by the midgut volvulus might lead to gastric rupture. We have to pay attention to bowel obstruction in cases of gastric rupture.