Tracking: gastric perforation in an infant Tension pneumoperitoneum as complication in an infant with gastric perforation

Gastric perforation is a very rare condition in pediatric patients. A potentially life-threatening complication is a (tension) pneumoperitoneum, a special form of intra-abdominal compartment syndrome. This article presents the case of a 12-week-old infant who was admitted with sepsis of unknown origin. With the development of a tender abdomen and free intra-abdominal air seen on the X-ray imaging, an urgent explorative laparotomy was indicated. During preoxygenation the infant experienced a pneumoperitoneum due to severe air trapping, which resulted in cardiorespiratory shock with the need for resuscitation. This could be resolved by acute decompression via laparotomy, which revealed a gastric perforation to be the cause of the deterioration. The pathophysiology of the cardiorespiratory shock is discussed and possible reasons for gastric perforations are depicted regarding different pediatric age groups. A special focus is placed on child abuse as the patient's history aroused suspicion. A conclusive reason for the perforation remains unknown. With the 4-week-old brother admitted because of an upper arm fracture of unknown origin the year after, child abuse was even more probable. The children were taken out of the family.