Necrosis of Anterior Wall of Stomach Presenting as Pneumoperitoneum in Neonates- Report of Two Cases with Review of Literature

Necrotising enterocolitis is a common disease that leads to low birth weight and preterm babies. Mostly small intestine and large intestine develop necrosis sparing stomach and duodenum. Necrosis involving the anterior wall of stomach and sparing other parts of Gastrointestinal (GI) tract is a rare entity, but can present in neonates with massive pneumoperitoneum. Though the exact aetiology is not known, it may be related to perinatal hypoxia. Case report of two preterm low birth weight babies who presented with pneumoperitoneum on day three of life had an area of anterior gastric wall necrosis with perforation peritonitis. The rest of GI tract was healthy. After excision of necrotic tissue, suture repair of viable stomach and feeding jejunostomy was done in both cases. These two neonates survived with intensive neonatal ICU care and gradual jejunostomy feeding. Gastric wall necrosis with perforation peritonitis is a rare entity in neonates with high mortality. Tip of nasogastric tube lying outside stomach shadow can give clue to the diagnosis. Survival can be improved by early surgery, good neonatal Intensive Care Unit (ICU) care and gradual jejunostomy feeding.