Neonatal gastric perforation enclosed by the lesser sac: a c
The present case has been reported in the journal Pediatrics and Neonatology.

A female preterm infant was born by cesarean delivery at a gestational age of 244/7 weeks with a birth weight of 523 g. On Day 8, mild abdominal distention and bilious gastric residuals were noted. Pneumoperitoneum was not evident in the plain abdominal radiographs.

On Day 9, a round, 4-cm translucent structure was observed in the left upper quadrant. Pneumoperitoneum was not evident in the lateral decubitus view. On Day 10, the translucent structure was still present; however, an upper gastrointestinal series did not delineate the structure.

On Day 12, pneumoperitoneum became apparent, and an emergency laparotomy was performed. During surgery, a 5-mm perforation was noted on the posterior wall of the stomach body and was enclosed by the lesser sac. The patient died at 40 days of age due to circulatory disturbance.

Lessons learnt:-
- Early diagnosis based on the presence of pneumoperitoneum on plain abdominal radiography and surgical intervention is key to successful management.

- However, prompt surgical intervention was not possible in our case because of the delayed appearance of pneumoperitoneum.

- Free gas was observed instead as a round, radiolucent structure due to entrapment by the lesser sac, the small part of the peritoneal cavity behind the lesser omentum and stomach.

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