Pneumo-omentocele - a Sign of Silent Lethal Neonatal Posterior Gastric Perforation

Case Report

Austin J Clin Case Rep. 2014;1(8): 1038.

Pneumo-omentocele - a Sign of Silent Lethal Neonatal Posterior Gastric Perforation

Govani DR1, Patel RR2, Patel RV3*, More B4, Bhimani SD5 and Vaghela SV6

1Medical Student, University of Birmingham Medical School, UK

2Department of Pediatrics, Saurashtra University, India

3Department of Ped Surgery, Saurashtra University, In

4Department of Paediatric Surgery, Leicester Royal Infirmary, UK

5Department of Ped Cardiology, Saurashtra University, India

6Department of Ped CT Surgery, Saurashtra University, India

*Corresponding author: Patel RV, Department of Surgery, Postgraduate Institute of Child Health and Research and K T Children Government Hospital, Saurashtra University, Rajkot 360001 Gujarat, India

Received: July 10, 2014; Accepted: Aug 10, 2014; Published: Aug 11, 2014


A case of silent lethal posterior neonatal gastric perforation in a term neonate who had severe respiratory distress syndrome following meconium aspiration and difficult intubation at birth has been reported. He underwent very successful and costly treatment of meconium aspiration with extracorporeal membrane oxygenation (ECMO) but succumbed to unrecognized silent posterior gastric perforation although clinically he deteriorated progressively following oral feeding, inflammatory markers started climbing and the radiological findings of lobulated collection of air in the two layers of greater omentum of the lesser sac boundary well outside the bowel outline were not timely co-ordinated leading to septicaemia, multiple organ failure and death.

Keywords: New born; Stomach; Perforation; Lobulated; Pneumoperitoneum; Intubation; Meconium aspiration; ECMO; Pneumo-omentocele; Lesser sac


Neonatal gastrointestinal perforations in general are relatively uncommon mainly seen in preterm babies as isolated perforation or as a consequence of necrotizing enterocolitis and gastric perforation in particular are rare and presents with catastrophic sequel and has very high mortality rates [1-15].

Case Presentation

A term male neonate had meconium aspiration syndrome at birth. His condition was poor, with APGAR scores of 2, 5 and 5 at 1, 5 and 10 minutes respectively. The infant had a difficult intubation and required aggressive resuscitation with intubation, ventilation, 100% oxygen and nil by mouth with intravenous fluids and antibiotics.

He was transferred to the regional extracorporeal membrane oxygenation (ECMO) service. He had a veno-arterial ECMO cannula inserted, radiograph confirmed position of the cannula but an abnormal loculated gas shadow was appreciated with the tip of the nasogastric tube beyond the shadow itself (Figure 1A).

Citation: Govani DR, Patel RR, Patel RV, More B, Bhimani SD and Vaghela SV. Pneumo-omentocele - a Sign of Silent Lethal Neonatal Posterior Gastric Perforation. Austin J Clin Case Rep. 2014;1(8): 1038. ISSN 2381-912X