Spontaneous Neonatal Gastric Perforation: A Case Report.

Spontaneous gastric perforation (SGP) is a rare but life-threatening surgical emergency in neonates, particularly among preterm infants. We report the case of a male neonate born at 33 weeks of gestation via spontaneous vaginal delivery, with a birth weight of 1,780 grams. The initial postnatal adaptation was satisfactory. However, on the second day of life, the infant developed sudden and severe abdominal distension associated with bilious vomiting and signs of respiratory distress. A plain abdominal radiograph revealed a massive pneumoperitoneum, highly suggestive of gastrointestinal perforation. The neonate underwent emergency exploratory laparotomy, which revealed a 2 cm linear perforation on the anterior wall of the stomach. The perforation was repaired primarily without the need for gastric resection. Despite early surgical intervention and aggressive postoperative management in a neonatal intensive care unit, the infant's condition deteriorated rapidly. He developed signs of sepsis, refractory shock, and multiorgan failure, and succumbed within 48 hours postoperatively. This case underscores the fulminant course and high mortality rate associated with SGP, especially in preterm neonates. It highlights the critical importance of maintaining a high index of suspicion in the presence of acute abdominal symptoms and radiologic findings, as early diagnosis and prompt surgical intervention are essential for improving outcomes in these vulnerable patients.