Spontaneous
gastric rupture of the newborn infant can be lethal. While the etiology of this problem is unknown, pneumatic
rupture of the stomach seems the most logical explanation. The
rupture mostly occurs in the anterior wall of the fundus near or on the greater curvature with in the first seven days of life. Three such patients have been managed during the past 5 years. These patients are presented in detail.
X-ray films of those 3 patients, of a case of
gastroesophageal reflux, and of some reported cases of impending
gastric rupture are also presented in an effort to better understand the pathogenesis of this gastric catastrophe. (1) Clinical findings of a double air fluid level in the upper stomach at the upright position found in one case and of the direction of advancement of the nasogastric tube enable us to consider the gastric organoaxial
volvulus as an etiological factor. (2) Plain x-ray and
barium study films of the case of
gastroesophageal reflux and of the reported cases of impending
gastric rupture also suggest some degree of
gastric volvulus as the cause of corresponding diseases. (3) Fluid accumulation in the fundus is facilitated by gastric organoaxial rotation and the fluid-filled fundus acts as a barrier to prevent
eructation. Retention of feeds occurs as a result of air accumulating at the pyloric end. In such situation of a fluid trap syndrome, tremendous intragastric pressures enough to cause
rupture may result when
vomiting occurs.