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Spontaneous gastric perforation in a 6-year-old child: a rare case report
Gobezu Assefa1, Bhan Makuach1, Biniyam Beyene Tabor2
1Gambella Town Primary Hospital Gambella, Ethiopia.
Insights
Spontaneous gastric perforation is a rare but serious condition in children. This case highlights gastric wall ischemia as a potential cause in a 6-year-old, emphasizing early diagnosis and surgical intervention for pediatric acute abdomen.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Pathology
Background:
- Spontaneous gastric perforation is a rare, life-threatening condition in children beyond the neonatal period.
- While common in neonates and adults, it is infrequent in older children, often with no clear cause.
Observation:
- A 6-year-old presented with acute abdominal distension and pain, showing pneumoperitoneum on radiography.
- Surgical exploration revealed a round perforation at the prepyloric region with confirmed ischemic changes.
- The patient had no history of trauma, toxins, or Helicobacter pylori infection.
Findings:
- Gastric wall ischemia is a suggested factor in spontaneous gastric perforation.
- Pathological examination indicated transmural necrosis of the gastric wall at the perforation site.
- This case adds to the limited literature, potentially offering insights into the etiology of spontaneous gastric perforation.
Implications:
- Spontaneous gastric perforation should be considered in the differential diagnosis of pediatric acute abdomen.
- Prompt diagnosis via clinical and radiographic assessment, followed by surgical intervention, is crucial for reducing mortality.
- This report emphasizes the need for high clinical and radiological suspicion in managing such rare pediatric cases.
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 Helicobacter pylori 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.
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