[Etiological consideration of neonatal gastric rupture: assumption of possible association with gastric volvulus and gastroesophageal reflux].
Spontaneous gastric rupture of the newborn infant can be lethal. While the etiology of this problem is unknown, pneumatic rupture of the stomach seems the most logical explanation. The rupture mostly occurs in the anterior wall of the fundus near or on the greater curvature with in the first seven days of life. Three such patients have been managed during the past 5 years. These patients are presented in detail. X-ray films of those 3 patients, of a case of gastroesophageal reflux, and of some reported cases of impending gastric rupture are also presented in an effort to better understand the pathogenesis of this gastric catastrophe. (1) Clinical findings of a double air fluid level in the upper stomach at the upright position found in one case and of the direction of advancement of the nasogastric tube enable us to consider the gastric organoaxial volvulus as an etiological factor. (2) Plain x-ray and barium study films of the case of gastroesophageal reflux and of the reported cases of impending gastric rupture also suggest some degree of gastric volvulus as the cause of corresponding diseases. (3) Fluid accumulation in the fundus is facilitated by gastric organoaxial rotation and the fluid-filled fundus acts as a barrier to prevent eructation. Retention of feeds occurs as a result of air accumulating at the pyloric end. In such situation of a fluid trap syndrome, tremendous intragastric pressures enough to cause rupture may result when vomiting occurs.
Tanigawa
N
N
Takahashi
K
K
Shimomatsuya
T
T
Muraoka
R
R
Konishi
Y
Y
Kuriyama
S
S
Ohama
K
K
D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012422:Rupture, Spontaneous; D013275:Stomach Rupture / Q000209:etiology*; D013277:Stomach Volvulus / Q000150:complications*