[Idiopathic gastric rupture in toddler: case report]

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Critical Care Medicine

Background:

• Idiopathic gastric rupture is exceptionally rare in pediatric populations, with most cases reported in neonates.
• This report details a unique case of gastric perforation in a 2-year-old toddler, a demographic rarely affected by this condition.

Observation:

• The patient presented with acute abdominal pain, nausea, vomiting, and abdominal distension, indicative of a surgical emergency.
• Immediate laparotomy revealed multiple perforations in the stomach's posterior wall, necessitating partial gastrectomy.
• Post-operatively, the patient developed shock, leukopenia, thrombocytopenia, and a subphrenic abscess caused by Candida galabrata.

Findings:

• Despite the severity, the patient received comprehensive intensive care, including mechanical ventilation, fluid resuscitation, vasoactive support, and broad-spectrum antibiotics.
• Surgical intervention for the abscess, combined with targeted antifungal and antibacterial therapies, led to clinical improvement.
• Extensive etiological investigations ruled out toxic, drug-induced, or autoimmune causes for the gastric rupture.

Implications:

• This case underscores the importance of prompt surgical intervention and intensive care management in pediatric idiopathic gastric rupture.
• It highlights the potential for fungal infections in post-operative abdominal complications and the need for appropriate antifungal therapy.
• The successful outcome in this rare pediatric case provides valuable insights for managing similar complex gastrointestinal emergencies in children.