P SPONTANEOUS GASTRIC PERF

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Here is a concise BGT (Bullet-Point Gist Tagline) summary:

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BGT – Spontaneous Gastric Perforation (Paediatric, Beyond Neonatal Period)

• Rare but life-threatening cause of acute abdomen in children beyond the neonatal period

• Often idiopathic, but associated causes include:

  • Gastric wall ischemia / transmural necrosis

  • Connective tissue disorders (e.g. Ehlers-Danlos syndrome)

  • Eating disorders (acute gastric dilatation, anorexia nervosa)

  • Infection (rarely Candida)

  • Malignancy

  • Bezoars

• Presents with:

  • Sudden severe abdominal pain

  • Distension

  • Vomiting

  • Pneumoperitoneum on imaging

• Diagnosis frequently delayed due to non-specific early symptoms

• Management principles:

  • Rapid resuscitation

  • Broad-spectrum antibiotics

  • Urgent surgical exploration

  • Repair or partial gastrectomy depending on necrosis

• Mortality reported up to ~30% in some paediatric series

• Prognosis linked to:

  • Degree of ischemia

  • Transmural necrosis

  • Preoperative physiological status

• Consider underlying systemic pathology in atypical cases

• High index of suspicion required in any child with acute abdomen + free air