Spontaneous gastric perforation in a 6-year-old child: a rare case report.

BACKGROUND AND IMPORTANCE

Spontaneous gastric perforation is a rare yet life-threatening condition, particularly in children beyond the neonatal period. While relatively common in neonates and occasionally seen in adults, its occurrence in older children is rare and often lacks identifiable causes.

CASE PRESENTATION

We report the case of a 6-year-old child who presented with acute abdominal distension and severe pain. Radiographic evaluation revealed pneumoperitoneum, indicative of viscus perforation. During the surgical exploration, a round perforation was identified at the prepyloric region. A pathological examination confirmed ischemic changes at the perforation site. The patient had no history of trauma, medication use, or ingestion of toxic substances and testing was negative.

CLINICAL DISCUSSION

Spontaneous gastric perforation beyond the neonatal period is uncommon. Studies suggested that gastric wall ischemia plays a role in the pathophysiology of gastric wall perforation. In one case series, pathological evaluation of five cases revealed transmural necrosis of the gastric wall. This case supplements the cohort potentially providing new insights into the etiology.

CONCLUSION

This case underscores the rarity of spontaneous gastric perforation in preschool-aged children and highlights the importance of its inclusion as a differential diagnosis in pediatric acute abdomen. Early diagnosis through clinical and radiographic assessments, followed by timely surgical intervention, is critical for reducing mortality. This report contributes to the limited literature on this condition and emphasizes the need for a high index of clinical and radiological suspicion to ensure prompt management.