DOI: http://dx.doi.org/10.18203/2349-2902.isj20213625

Extensive gastric necrosis in an infant

Suraj R. Gandhi, Neha S. Shenoy, Vini Joseph, Apoorva P. Makan, Syamantak Basu, Akriti R. Tulsian, Hemanshi S. Shah

Abstract


Gastric necrosis is a rare condition, more so in children and can be potentially fatal. The sloughing of the necrosed wall results in perforations or large defects in the gastric wall.  We report a rare case of extensive gastric necrosis in a 2 months old female infant, managed successfully. Child presented with non-bilious vomiting and excessive cry. There was history of recurrent upper abdominal distension. X-ray of abdomen showed massive pneumoperitoneum. Intra operatively, posterior gastric wall was sloughed off and lower end of feeding tube was lying in the peritoneal cavity. Necrotic wall was debrided and stomach tube was created from remaining anterior gastric wall. Gastrostomy and jejunostomy was done. Post-operative period was uneventful. Dye study at three months showed good gastric capacity. Stomach being a well vascularised organ, necrosis is rare. There is varied etiology of gastric necrosis, volvulus being one of them. Gastric volvulus might be associated with other congenital anomalies like eventration, asplenia, wandering spleen. The incidence of perforation in gastric volvulus with necrosis is 5-28% and a mortality of 50% is reported with such perforations. Vigilant clinical observation in pediatric patients with upper abdominal distension and pain can point the diagnosis and prevent fatal outcome.


Keywords


Gastric, Necrosis, Perforation, Volvulus, Paediatric, Infant

Full Text:

PDF

References


Trecroci I, Morabito G, Romano C, Salamone I. Gastric volvulus in children-a diagnostic problem: two case reports. J Med Case Rep. 2016;10:138.

Ito TE, Hasnie R, Crosby DL, Milbrandt JC, Ettema S, Duong M. Gastric volvulus complication in an infant with undiagnosed congenital diaphragmatic hernia presenting with acute respiratory distress. Pediatr Emerg Care. 2012;28(10):1078-80.

Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol. 2013;19:3918-30.

Do PH, Kang YS, Cahill P. Gastric infarction following gastric bypass surgery. J Radiol Case Rep. 2016;10(4):16-22.

Davoodabadi A, Talari HR, Jahanbakhsh M. Isolated Common Hepatic Artery Branch Thrombosis: Results and Risk Factors. Acta Med Iran. 2016;54(9):610-3.

Mukhopadhyay M, Saha AK, Sarkar A, Tripathi SN, Biswas S, Mandal D, et al. Gastric gangrene due to necrotizing gastritis. Indian J Surg. 2011;73(1):65-7.

Kulkarni R, Thakur S. Invasive gastric mucormycosis- a Case Report. Indian J Surg. 2015;77:87-9.

Shukla RM, Mandal KC, Maitra S, Ray A, Sarkar R, Mukhopadhyay B, et al. Gastric volvulus with partial and complete gastric necrosis. J Indian Assoc Pediatr Surg. 2014;19(1):49-51.

Gupta V, Chandra A, Gupta P. Diaphragmatic eventration complicated by gastric volvulus with perforation. S Afr J Surg. 2012;50:90-1.

Krishnakumar G, Mallikarjun U, Reshma D. Massive gastric necrosis with delayed presentation of congenital diaphragmatic hernia- is salvage possible? Annals Ped Surg. 2020;16:31.

Aoyama K, Tateishi K. Gastric volvulus in three children with asplenic syndrome. J Pediatr Surg. 1986;21:307-10.

Chen TY, Liu HK, Yang MC, Yang YN, Ko PJ, Su YT, et al. Neonatal gastric perforation: a report of two cases and a systematic review. Medicine. 2018;97(17):369.

Adachi Y, Takamatsu H, Noguchi H, Tahara H, Mukai M, Akiyama H. Spontaneous rupture of the stomach in preschool age children: a report of two cases. Surg Today. 1998;28(1):79-82.

Wang K, Cai S, He L, Peng C, Pang W, Wang Z, et al. Pediatric gastric perforation beyond neonatal period: 8-year experience with 20 patients. Pediatr Neonatol. 2019;60(6):634-40.

Libeer F, Vanhamel N, Huyghe M, Verlinden E. Spontaneous gastric rupture in non-neonatal children: A case report. Acta Chir Belg. 2007; 107:560-3.

Akalonu A, Yasrebi M, Molle Rios Z. Spontaneous gastric perforation in two adolescents. Am J Case Rep. 2016;17:694-8.

Cribbs RK, Gow KW, Wulkan M. Gastric volvulus in infants and children. Pediatrics. 2008;122:752-62.