Large-Volume Pneumoperitoneum in a Neonate: A Rare Case of Necrotizing Gastritis

Neonatal spontaneous gastric perforations are rare but are associated with high mortality rates. They usually occur within the first week of life, with a sudden onset of abdominal distension. Imaging often shows pneumoperitoneum. Gastric perforations require emergent surgical management. We report a case of a two-day-old male with spontaneous patchy gastric gangrene and perforation of the greater curvature. The patient presented with abdominal distension after initiation of feeds. An X-ray of the abdomen revealed a large-volume pneumoperitoneum. The patient underwent emergent exploratory laparotomy, partial segmental gastrectomy, and primary closure in two layers. The patient started tolerating feeds on postoperative day 8. Our case underscores the importance of considering neonatal spontaneous gastric perforation in the differential diagnosis of pneumoperitoneum. Large-volume pneumoperitoneum is a pathognomonic finding of necrotizing gastritis and gastric perforation in neonates and can lead to fatal respiratory decompensation. Early diagnosis and surgical intervention are imperative to improve prognosis.