Necrotizing enterocolitis with gastric perforation in a 24-day old preterm neonate
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.
© 2026 Tamas Toth, Reka Borka-Balas, Manuela Cucerea, Radu-Alexandru Prisca, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
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