Etiology of neonatal gastric perforation: a review of 20 years' experience.
OBJECTIVE
Gastric perforation (GP) of the newborn is a rare, serious, and life-threatening problem, and its etiology remains unclear. Although historically GP has often been described as "spontaneous'', some cases are non-spontaneous. The aim of the present study was to review cases of GP and to discuss its etiology in a single prefecture in Japan over a period of 20 years.


METHODS
Eleven cases with GP that underwent surgery in 4 institutions in the Chiba Prefecture from 1991 to 2010 were reviewed and divided into 2 groups: the early (1991-2000, n = 7) and late (2001-2010, n = 4) groups.


RESULTS
No factors were observed that could have caused GP other than malformations associated with distal obstruction (3 midgut volvulus, 1 jejunal stenosis, 1 diaphragm eventration). Distal obstruction was present in 1 case in the early group and all 4 cases in the late group (p = 0.015). While the incidence of GP did not change over the 20-year period reviewed, the incidence of GP without distal obstruction significantly decreased in the late group.


CONCLUSIONS
The proportion of patients with GP and distal obstruction increased and true "spontaneous" cases of GP decreased over time. The possible presence of distal obstruction should be evaluated during surgery for GP.
Department of Pediatric Surgery, Matsudo City Hospital Children's Medical Center, 4005 Kamihongo, Matsudo, Chiba, 271-8511, Japan. kta@cc.rim.or.jp
Keita
K
Terui
Jun
J
Iwai
Shin-ichi
S
Yamada
Ayako
A
Takenouchi
Mitsuyuki
M
Nakata
Shugo
S
Komatsu
Hideo
H
Yoshida
D000328:Adult; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D007564:Japan; D008297:Male; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D013275:Stomach Rupture / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015996:Survival Rate / Q000639:trends