Nasogastric tube–induced gastric perforation revealing incidental congenital intestinal malrotation in a term neonate: a case report from a resource-limited setting
Year: 2026
Type: article
Study design: Case Report
Abstract: Background: Neonatal gastric perforation (NGP) is a rare but life-threatening surgical emergency that usually affects preterm or critically ill neonates. Nasogastric tube (NGT)-induced perforation in term neonates is exceptionally uncommon. Coexisting congenital intestinal malrotation further increases diagnostic and operative complexity, especially in resource-limited settings. Case presentation: We report on a 6-day-old term male neonate weighing 2.5 kg who initially passed meconium and tolerated breastfeeding. On day 4 of life, he developed failure to pass stool, intermittent vomiting, and progressive abdominal distension. An NGT was inserted at a peripheral hospital for decompression. Two days later, worsening bilious vomiting, abdominal distension, and lethargy prompted referral. Laboratory investigations showed mild leukocytosis. Abdominal radiography demonstrated diffuse abdominal opacification and multiple air-fluid levels without definite pneumoperitoneum. An emergency exploratory laparotomy revealed gross peritoneal contamination and a 4 cm gastric perforation along the greater curvature, with the NGT exposed within the peritoneal cavity. Incidental congenital intestinal malrotation without volvulus was also identified. Primary gastric repair and peritoneal lavage were performed, while formal Ladd's procedure was deferred because no obstructing Ladd's bands were present. The neonate recovered well without postoperative complications over a 30-day follow-up period. Discussion: NGT-induced gastric perforation in term neonates is extremely rare and may present with nonspecific clinical and radiological findings, delaying diagnosis and treatment. Incidental malrotation represents an additional surgical consideration requiring close postoperative surveillance. Absence of pneumoperitoneum on radiography should not entirely exclude gastrointestinal perforation in symptomatic neonates. Conclusion: Early recognition, careful NGT monitoring, and prompt surgical intervention are essential for favorable outcomes in NGP.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,090
OpenAlex ID: W7225693976