GASTRIC NECROSIS IN NEWBORNS - A REPORT OF 11 CASES

Eleven neonates ranging in gestational age from 34 to 40 weeks present ed with gastric necrosis. The 4 full-term neonates showed sudden-onset hemorrage and ''coffee-ground'' vomiting; in the 7 premature babies t he initial clinical finding was abdominal distention. The criteria for diagnosis were: perinatal distress in prematures and transient neonat al respiratory distress in full-term babies. Radiographic evidence of gastric distention was typical and preceded clinical signs of hemateme sis and gastric perforation. Surgery was performed in 8 patients; 3 re ceived medical treatment. At surgery 1 total and 3 subtotal gastrectom ies and 4 segmental gastric resections were performed. Three of these patients died post-operatively as a consequence of multi-organ failure ; a second look was necessary in one patient 1 week after surgery beca use of prepyloric perforation due to ulcers. Biopsy specimens taken fr om the site of perforation demonstrated extensive necrosis; ulceration was disseminated in the surrounding gastric mucosa; no signs of phlog osis were detected. The diagnosis, treatment, and physiopathologic con siderations are reviewed.