Case Report: Necrotizing Enterocolitis with Gastric Perforation in a 24-day old preterm neonate

Authors

  • Tamas Toth Spitalul Clinic Judetean de Urgenta Târgu Mureş image/svg+xml , Institution Organizing University Doctoral Studies (IOSUD) George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures; Pediatric Surgery and Orthopedics Department, Targu Mures Emergency Clinical County Hospital, Targu Mures Author
  • Reka Borka-Balas Spitalul Clinic Judetean de Urgenta Târgu Mureş image/svg+xml , Pediatric Clinic I, Targu Mures Emergency Clinical County Hospital; George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures Author
  • Manuela Cucerea Spitalul Clinic Judetean de Urgenta Târgu Mureş image/svg+xml , Neonatology Department, Targu Mures Emergency Clinical County Hospital; George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures Author
  • Radu-Alexandru Prisca Pediatric Surgery and Orthopedics Department, Targu Mures Emergency Clinical County Hospital, Targu Mures Author

DOI:

https://doi.org/10.62838/jccm-2026-0023

Keywords:

neonatal gastric perforation;, necrotizing enterocolitis, extremely low birth weight, prematurity, pneumoperitoneum

Abstract

Introduction: Neonatal gastric perforation (NGP) is a rare, life-threatening surgical emergency that predominantly affects premature and extremely low birth weight (ELBW) infants and remains associated with high mortality.

Case presentation: A 600 g female infant born at 25/26 weeks of gestational age developed necrotizing enterocolitis (NEC) during the third postnatal week and deteriorated with abdominal distension and pneumoperitoneum. Emergency laparotomy on day 24 revealed a single posterior gastric wall perforation with circumferential necrotic margins; the nasogastric tube tip was located at the defect. After minimal debridement, and primary two-layer closure, the infant survived a prolonged intensive care course complicated by recurrent sepsis, cholestasis, bronchopulmonary dysplasia, and later adhesive obstruction requiring adhesiolysis.

Conclusions: Gastric perforation may represent an uncommon manifestation of severe NEC in ELBW infants. Delayed onset, necrotic margins, and systemic inflammatory deterioration may favor ischemic NEC-related injury over iatrogenic trauma. Early radiographic evaluation and prompt surgical exploration are crucial for survival.

 

 

 

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Published

16-03-2026

Issue

Vol. 12 No. 3 (2026): July

Section

Case report/series

Categories

License

Copyright (c) 2026 Tamas Toth, Reka Borka-Balas, Manuela Cucerea, Radu-Alexandru Prisca (Author)

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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How to Cite

1.
Toth T, Borka-Balas R, Cucerea M, Prisca R-A. Case Report: Necrotizing Enterocolitis with Gastric Perforation in a 24-day old preterm neonate. J Crit Care Med [Internet]. 2026 Mar. 16 [cited 2026 Aug. 6];12(3):453-8. Available from: https://ojs.jccm.ro/index.php/jccm/article/view/38