Spontaneous linear tears of the stomach in the newborn infant

Spontaneous linear tears in the stomach of the newborn infant can be lethal. While the etiology of this problem is unknown, pneumatic rupture of the stomach seems to be the most logical explanation for the gastric tear. The mechanism is much like Boerhaave's syndrome, the stomach being the target organ. Tremendous intragastric pressures may result because of incoordination and immaturity of the vomiting mechanism in the infant. The perforation occurs characteristically within the first seven days of life. Mortality is high, and surgical intervention is urgent. Three such patients have been successfully managed during the past 15 years. These patients are presented in detail, and the esophageal motilities in two of the survivors are presented. Pressure studies with rupture of cadaver stomachs and esophagi of newborn infants and adults are also presented in an effort to better understand the pathogenesis of this gastric catastrophy. Discussion of the diagnosis and management is also included in the presentation.