• Advances in pediatric surgery
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• v.11 no.2
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• pp.123-130
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• 2005

Gastric perforation of the newborn is a rare and life threatening problem. The pathogenesis of gastric perforation is not clear. Since ischemia is responsible for intestinal perforation, a similar mechanism may result in gastric perforation. Twelve patients with neonatal gastric perforation who were treated at the Department of Pediatric Surgery, Hanyang University Hospital from 1987 to 2002 were reviewed. Eight patients were male and four female. The age of perforation was 1 day to 8 days of life. Ten patients were operated upon and 2 patients were treated nonoperatively. The perforation site was located on the anterior wall along the greater curvature of the stomach in 8 patients and along the lessor curvature of the stomach in 2. The precipitating factors were prematurity, gastroschisis, mechanical ventilation, intestinal obstruction, cyanotic heart disease and indomethacine medication. In 5 cases the cause of perforation was not identified. The mortality rate was 25 % (3 of 12). Earlier recognition and treatment were thought to be crucial prognostic factors.

• Journal of Chest Surgery
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• v.31 no.9
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• pp.911-914
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• 1998

We report our experience with 2 cases of perforation of intrathoracic stomach after Ivor Lewis operation for esophageal cancer. There was no problem in the anastomotic site, but the drainage from pleural cavity increased after oral intake. The stomach perforation was proved by rethoracotomy. The perforation site was repaired by sutures with pedicled intercostal muscle.

• Journal of The Korean Society of Clinical Toxicology
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• v.16 no.2
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• pp.161-164
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• 2018

The ingestion of corrosive substances often leads to severe morbidity and mortality. Acids produce coagulation necrosis with a lesser degree of penetration, whereas alkalis produce liquefactive necrosis with penetration. Acetic acid is a clear, colorless organic acid with a pungent, vinegar-like odor. The ingestion of highly concentrated acetic acid (glacial acetic acid) may cause a range of complications. On the other hand, perforation of the stomach is extremely rare but it has a high mortality rate. This paper reports a case of perforation of the stomach after the ingestion of glacial acetic acid with suicidal intent in an otherwise healthy 76-year-old woman.

• Journal of Chest Surgery
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• v.55 no.1
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• pp.85-87
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• 2022

Diaphragmatic hernias have been reported in 0.8%-1.6% of patients who experience blunt chest trauma. The hernia is assumed to form as a result of direct diaphragmatic violation or significant intraabdominal or intrathoracic pressure caused by the trauma. Some reports have described cases of delayed diaphragmatic hernia and subsequent stomach perforation that occurred a few days to several years after an accident. We report an extremely rare case of diaphragmatic herniation in which the process from initial blunt trauma to visceral organ perforation took only 2 days, without any evidence of herniation on the initial X-ray or computed tomography. Delayed diaphragmatic herniation and subsequent visceral organ perforation should not be missed during the period immediately after blunt chest trauma.

• Journal of Chest Surgery
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• v.6 no.2
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• pp.237-242
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• 1973

Two cases of traumatic diaphragmatic hernia are reported, who were operated on in this department during the last 12 months` period. The first case, a 34 year old male, fell from 6 meters` height while he was working on electric pole. He sustained rib fractures, left 8th, 9th and 10th rib, left diaphragmatic rupture and ileal perforation. In the pleural cavity, there were stomach, omentum, left lobe of liver, transverse colon and ileum, which were reduced into the peritoneal cavity, and the diaphragmatic aperture was closed through anterolateral thoracotomy. After closure of the thoracic incision, median abdominal incision was made and closed the ileal perforation by primary suture. The second case was a 19 year old tyre repairman, who felt abrupt severe abdominal pain during lifting a heavy lyre. A barium study revealed a marked displacement of the stomach into the left pleural cavity. Immediately, thoracotomy was performed and closed the ruptured diaphragm after reduction of the herniated stomach, omentum, transverse colon, spleen and small intestine. The size of the diaphragmatic aperture were measured 17cm. in first case and 12cm. in the other respectively. Both cases discharged after uneventful recovery.

• Advances in pediatric surgery
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• v.9 no.1
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• pp.30-34
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• 2003

Spontaneous gastric perforation in the newborn is a rare disease that requires early diagnosis and prompt surgical treatment. Between 1988 and 2001 at the Department of Pediatric Surgery. Kyungpool National University Hospital, 9 cases of spontaneous gastric perforation were treated. Seven were males and two females. The mean gestational age and birth weight were 36.7 weeks and 2,455 g respectively. All patients presented with severe abdominal distention and pneumoperitoneum on cross table lateral film of the abdomen. Perforations were located on the anterior wall along the greater curvature of the stomach in six and on the posterior wall along the greater curvature in two. One case showed two sites of perforation on the anterior and posterior wall along the greater curvature. Six patients were managed with debridement and primary closure and the others with debridement and partial gastrectomy. Peritoneal drainage was not performed. There were four deaths; two from sepsis due to leakage from the anastomotic site, one as a result of acute renal failure, and the other by associated respiratory distress syndrome. Spontaneous gastric perforation in the newborn is usually located along the greater curvature. Elevated intragastric pressure is a possible cause of the perforation. Poor prognosis is related to associated diseases and prematurity.

• Journal of Veterinary Clinics
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• v.32 no.1
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• pp.49-55
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• 2015

This study was retrospectively investigated the clinical features, diagnostic imaging, treatment, and prognosis of foreign bodies according to alimentary site and type of foreign body, in 143 dogs. Among 28 breeds, Maltese, Shih Tzu, and terriers including the Yorkshire terrier were presented with high prevalence. Bone was the most commonly identified (33%) foreign body regardless of alimentary site. Approximately 76% of foreign bodies were in the stomach and small intestine. All esophageal foreign bodies were diagnosed on survey radiography, with the most common location being the caudal thoracic esophageal segment. Further diagnostic examinations including ultrasonography or contrast studies were additionally performed to detect radiolucent foreign bodies and perforation or leakage in the stomach and intestine. However, most seeds could be identified based on the characteristic features such as hyperdense thin double lines and inner gas on survey radiography. In conclusion, complications such as peritonitis and intestinal perforation were mainly observed in cases with seeds and linear foreign bodies. Especially, fabric foreign bodies could be induce peritonitis and re-perforation with high prevalence after surgical correction.

• Clinical and Experimental Pediatrics
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• v.58 no.8
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• pp.288-293
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• 2015

Purpose: In this study, we aimed to review the clinical presentation of preterm infants with gastrointestinal perforations and compare the clinical features of gastric perforation with other intestinal perforations. Methods: The medical records of preterm neonates with pneumoperitoneum, admitted to the neonatal intensive care unit (NICU) between January 1994 and December 2013, were retrospectively reviewed. Results: Twenty-one preterm infants underwent exploratory laparotomy to investigate the cause of the pneumoperitoneum. The sample consisted of five patients (23.8%) with gastric perforation and 16 patients (76.2%) with intestinal perforation. No statistical differences were found in the birth history and other perinatal factors between the two groups. Underlying necrotizing enterocolitis, bilious vomiting, and paralytic ileus preceding the perforation were statistically more common in the intestinal perforation group. All preterm infants with gastric perforation survived to discharge; however, six preterm infants with intestinal perforation expired during treatment in the NICU. In the gastric perforation group, sudden pneumoperitoneum was the most common finding, and the mean age at diagnosis was $4.4{\pm}1.7days$ of life. The location and size of the perforations varied, and simple closure or partial gastrectomy was performed. Conclusion: Patients with gastric perforation did not have a common clinical finding preceding the perforation diagnosis. Although mortality in previous studies was high, all patients survived to discharge in the present study. When a preterm infant aged less than one week presents with sudden abdominal distension and pneumoperitoneum, gastric perforation should first be excluded. Prompt exploratory laparotomy will increase the survival rates of these infants.

• Journal of The Korean Society of Clinical Toxicology
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• v.2 no.1
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• pp.58-62
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• 2004

Acid ingestion can cause not only caustic injury on esophagus and stomach but also fatal outcome through systemic complications. We report the case of a patient who died early after severe caustic injury with strong acid. A 38-year-old man who ingested about 400ml of hydrochloric acid of unknown concentration was transferred to our hospital from a private clinic, in which he was managed with gastric irrigation through a nasogastric tube. He was complaining dyspnea and abdominal pain. Physical examination demonstrated tenderness and rebound tenderness on epigastric region. Severe metabolic acidosis and leukocytosis were noted. Radiological findings suggested perforation of gastrointestinal tract, although the physical signs were not typical. Endoscopy revealed caustic injuries of grade I on esophagus and of grade Ⅲ on stomach, which indicate more severe injury on the stomach than on the esophagus. Exploratory surgery was recommended but unfortunately not permitted by his family. Despite intensive measures, his vital signs deteriorated rapidly and he died 50 hours after the ingestion.

• Advances in pediatric surgery
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• v.2 no.2
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• pp.110-114
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• 1996

Spontaneous gastric perforation is an important but rare cause of gastrointestinal perforation in neonates. Just over 200 cases have been reported in the literatures. In spite of recent surgical advances in its managements, mortality rate has been reported as high as 25-50%. Because of physiologic differences, immature immune mechanisms, variations in gastrointestinal flora and poor localization of perforation, a neonate with gastric perforation is at high risk. The pathogenesis is greatly debated. Five patients with spontaneous neonatal gastric perforation who were operated upon at the Department of Pediatric Surgery, Seoul National University Hospital from 1980 to 1993 were reviewed. Four patients were male and one female. The first indication of perforation was 1 day to 6 days of life. All of 5 perforations were located along the greater curvature of the stomach. The size of perforation ranged from 2 cm to 10 cm. Debridement and primary closure were performed in all patients. The operative mortality was 40%(2 of 5). The cause of perforation was not identified in all cases. Prematurity and necrotizing enterocolitis, synchronous or metachronous, were thought to he crucial prognostic factors. Earlier recognition and surgical intervention are necessary to reduce morbidity and mortality.