Spontaneous Gastric Perforation in a 12-Year-Old Adolescent Girl: A Case Report and Literature Review

Spontaneous Gastric Perforation in a 12-Year-Old Adolescent Girl: A Case Report and Literature Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Spontaneous Gastric Perforation in a 12-Year-Old Adolescent Girl: A Case Report and Literature Review Lisong Shao, Lian’en Zhang, Weijun Li, Yuanlong Han This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9399435/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 11 You are reading this latest preprint version Abstract Background Spontaneous gastric perforation (SGP) is a rare but life-threatening cause of acute abdomen. Although it occurs predominantly in neonates and is occasionally reported in adults, it is only rarely reported in older children, particularly adolescents. Because of its rarity and nonspecific presentation, SGP in this age group is easily misdiagnosed, resulting in delayed treatment. We report a 12-year-old adolescent girl with SGP, representing a rarely reported case in the adolescent age group in both the domestic and international literature, in whom emergency laparoscopic exploration secured an early diagnosis and enabled successful repair. This case, together with a review of the literature, expands the limited clinical experience with SGP in adolescents, highlights the clinical features and rarity of pediatric SGP, and underscores the importance of timely recognition and laparoscopic management in improving outcomes. Case presentation A 12-year-old adolescent girl presented with a 5-hour history of abdominal pain. She developed sudden severe epigastric pain, assumed an antalgic posture, and had nausea and vomiting. Plain abdominal radiography showed a large amount of free air beneath both hemidiaphragms, suggesting gastrointestinal perforation. Abdominal computed tomography further demonstrated massive intraperitoneal free air, consistent with gastric perforation and diffuse peritonitis. With a presumptive diagnosis of gastric perforation with acute peritonitis, she underwent emergency laparoscopic exploration. Intraoperatively, a round perforation was identified in the prepyloric region of the posterior gastric wall, while the remainder of the stomach appeared normal. The defect was repaired by two-layer primary closure. The patient recovered well after postoperative anti-infective and supportive treatment. Conclusions Although spontaneous gastric perforation has only rarely been reported in older children and adolescents, it should still be considered in the differential diagnosis of pediatric acute abdomen. Prompt imaging evaluation, particularly plain abdominal radiography and computed tomography, is critical for early diagnosis. Timely laparoscopic exploration represents a safe and minimally invasive option for both definitive diagnosis and treatment. This case, together with the literature review, adds to the limited clinical experience with pediatric spontaneous gastric perforation and underscores the importance of early recognition and minimally invasive surgical intervention in improving clinical outcomes. Spontaneous gastric perforation pediatric acute abdomen laparoscopy children case report Figures Figure 1 Figure 2 Figure 3 1 Introduction Spontaneous gastric perforation (SGP) is a rare but life-threatening surgical emergency. It is more common in the neonatal period and has occasionally been reported in adults[ 1 ], but is uncommon in older children and only rarely reported in post-school-age children and adolescents [ 2 – 5 ]. SGP typically has an abrupt onset and lacks specific clinical features, and its early manifestations often overlap with those of other causes of acute abdomen, making misdiagnosis and delayed treatment common. If diagnosis and intervention are not achieved promptly, leakage of gastric contents can rapidly lead to diffuse peritonitis, sepsis, shock, and multiple organ dysfunction, markedly increasing the risk of death and adversely affecting both short-term recovery and long-term prognosis [ 5 , 6 ]. Although SGP has been relatively well documented in neonates, where it is frequently associated with congenital gastrointestinal malformations or developmental defects of the gastric wall [ 7 , 8 ], its occurrence in post-school-age children and adolescents remains poorly characterized. Critically, the available domestic and international literature in this age group is still extremely limited and consists mainly of isolated case reports [ 2 – 6 ]. In contrast, gastric perforation in children is more often attributable to identifiable causes, such as trauma, peptic ulcer disease, corrosive ingestion, accidental ingestion of magnetic beads, medication exposure (e.g., nonsteroidal anti-inflammatory drugs or corticosteroids), or stress-related injury [ 9 – 12 ]. This striking lack of evidence highlights a clear gap in current knowledge regarding the recognition and management of SGP in older pediatric patients. Here, we report a case of spontaneous gastric perforation in a 12-year-old adolescent girl, representing a rarely reported presentation in the adolescent age group in both the domestic and international literature, who was successfully treated. We focus on the clinical presentation, imaging findings, diagnostic process, and surgical management. By integrating this case with a review of the domestic and international literature, we aim to improve awareness of SGP in pediatric acute abdomen, evaluate the clinical value of minimally invasive surgery in children with SGP, and provide evidence to inform clinical practice. 2 Case presentation A 12-year- and 6-month-old girl was brought to the emergency department of our hospital by her parents on October 17, 2025, with a 5-hour history of abdominal pain. She reported the sudden onset of marked epigastric pain, accompanied by fatigue and poor appetite. The pain subsequently became diffuse and involved the entire abdomen, and she assumed an antalgic posture. She also experienced multiple episodes of non-projectile vomiting consisting mainly of gastric contents without bile. She had no diarrhea, urinary frequency, or urinary urgency. On physical examination, her body temperature was 37.6°C. Abdominal distension was present, with mild abdominal muscle guarding. No abnormal mass was palpable. Deep tenderness was noted throughout the abdomen, while rebound tenderness was not elicited in the right lower quadrant. Bowel sounds were decreased. Detailed history taking from both the patient and her guardians confirmed that she had previously been in good health, with no relevant family history, no prior episodes of abdominal pain, and no recent history of trauma, foreign body ingestion, medication use, or corrosive substance ingestion. There was also no history of binge eating before symptom onset. An upright abdominal radiograph obtained in the emergency department showed a large amount of free air beneath both hemidiaphragms, raising strong suspicion of gastrointestinal perforation (Fig. 1 ). To further clarify the diagnosis, abdominal computed tomography was performed immediately and demonstrated a large volume of free intraperitoneal air (Fig. 2 ), consistent with gastrointestinal perforation with diffuse peritonitis. The preliminary diagnosis was gastrointestinal perforation with acute diffuse peritonitis. Following admission, the patient immediately underwent laboratory investigations, including complete blood count, coagulation profile, liver and renal function tests, and screening for infectious diseases. However, the white blood cell count and C-reactive protein level were only mildly elevated and not markedly abnormal. No contraindications to surgery were identified. One hour after emergency admission, she underwent laparoscopic exploration under general anesthesia. Prophylactic antibiotics were administered 30 minutes before surgery. Pneumoperitoneum was established through one 5-mm periumbilical incision and two 3-mm working ports. Intraoperatively, a 0.5 × 0.5 cm round perforation was identified in the prepyloric region of the posterior gastric wall. No ulcer scar was seen around the perforation, and no abnormalities were found in the remainder of the stomach or in other intra-abdominal organs. A small amount of purulent exudate was present in the peritoneal cavity (Fig. 3 ). The perforation was repaired laparoscopically with a two-layer suture closure, and the repair was reinforced by coverage with the greater omentum. After peritoneal irrigation, a nasogastric tube was placed and the abdomen was closed. The procedure was completed uneventfully, with an operative time of 90 minutes and an estimated blood loss of approximately 3 mL. On postoperative day 1, a ^13C urea breath test for Helicobacter pylori was performed and was negative. The postoperative course was uneventful. The patient received ceftriaxone for anti-infective therapy and omeprazole for acid suppression and gastric protection. She was kept nil per os for 2 days with intravenous fluid support, resumed a liquid diet on postoperative day 3, and had the nasogastric tube removed the same day. She was discharged on postoperative day 5. Based on the clinical presentation, medical history, and examination findings, the final postoperative diagnosis was spontaneous gastric perforation in a child. At follow-up 1 week, 1 month, and 2 months after discharge, she remained well, with no abdominal pain or other gastrointestinal symptoms, and had returned to school and normal physical activity. Ethics approval and consent to participate This case report was approved by the Medical Ethics Committee of Shaoxing Women and Children’s Hospital (approval no. IRB-AF/37-2.0). Written informed consent for publication was obtained from the patient’s legal guardian. 3 Discussion 3.1 Rarity and possible mechanisms Spontaneous gastric perforation (SGP) is only rarely reported in older children, particularly in adolescents [6,3-5]. Our literature review (Table 1) showed that reported cases of spontaneous gastric perforation beyond 1 year of age remain scarce and consist mainly of isolated case reports and small retrospective studies. Most reported patients were infants or preschool-aged children, and a substantial proportion of cases were fatal [3-6,22]. In contrast, successfully treated cases in adolescents, such as the present case, have been only sporadically reported in the domestic and international literature [3,4]. Precisely because of its rarity, SGP is easily overlooked in clinical practice, where limited diagnostic suspicion and insufficient awareness may delay recognition and treatment, allowing rapid progression to diffuse peritonitis, septic shock, and even death [5,6,22]. Nevertheless, the epidemiological characteristics and pathogenesis of SGP remain poorly defined. Previous reports have suggested a relative predominance of female patients, and a similar pattern has also been observed in preschool-aged children [5].However, this single case should be regarded only as an additional clinical observation, as the currently available evidence is derived from extremely small samples and remains insufficient to support a definite sex predilection for this condition. The risk factors for spontaneous neonatal gastric perforation (SNGP) have been more extensively discussed and are commonly associated with perinatal asphyxia, excessive mechanical ventilation, prematurity with low birth weight, and prolonged corticosteroid exposure. Other proposed factors include incomplete embryonic development, structural abnormalities of the gastric wall, and a reduced number of interstitial cells of Cajal (ICC) [7,8,26,27]. By contrast, gastric perforation in older children and adults is usually secondary to identifiable causes, such as trauma, corrosive ingestion, gastric ulceration, gastric tuberculosis, Helicobacter pylori infection, or Burkitt lymphoma during chemotherapy [9,11,12]. In pediatric SGP, increased intragastric pressure has been considered one of the most important potential risk factors. Previous case reports have suggested that binge eating, or rapid ingestion of a large amount of food in patients with Prader–Willi syndrome, may result in marked elevation of intragastric pressure and acute gastric dilatation [14,15,18,28]. It has been reported that when intragastric pressure exceeds 30 cm H₂O, venous return may be compromised, leading to ischemia of the gastric wall and, ultimately, perforation [28]. In addition, underlying conditions such as seizures and neurological disorders have also been implicated in some cases, possibly through gastric wall injury or disordered gastrointestinal motility [4,23]. In the present case, the patient had no family history, no history of trauma, no prior chronic abdominal pain, and no history of medication use. She had not ingested a foreign body or corrosive substance, tested negative for H. pylori , and showed no intraoperative evidence of peptic ulcer disease or neoplastic lesions. Furthermore, she had no other obvious stress-related triggers and did not exhibit any clinical features suggestive of Prader-Willi syndrome, findings that are highly consistent with those reported in previous case reports. Therefore, in adolescent patients presenting with acute abdomen, especially girls, spontaneous gastric perforation should be included in the differential diagnosis in addition to more common conditions such as appendicitis, gynecological emergencies, intestinal perforation, and intestinal obstruction. This case broadens the age spectrum of pediatric SGP by adding evidence from adolescence and further suggests that spontaneous gastric perforation may occur even in the absence of typical high-risk factors. As such, it may provide a useful clinical reference for improving recognition of this condition and deepening understanding of its possible mechanisms. 3.2 Imaging features and early diagnosis The clinical manifestations of spontaneous gastric perforation in children are nonspecific and usually include abdominal pain, abdominal distension, vomiting, and dyspnea [5,22,23]. The typical presentation is the sudden onset of severe abdominal pain accompanied by signs of peritonitis. However, younger children often have limited ability to localize or accurately describe pain, making this condition easily confused with other causes of acute abdomen. In the present case, the patient’s sudden epigastric pain rapidly progressed to generalized abdominal pain and was accompanied by low-grade fever, poor appetite, abdominal distension, and repeated non-projectile vomiting, all of which strongly suggested perforation of an intra-abdominal viscus. In addition, diffuse abdominal tenderness in children may also occur in conditions other than gastrointestinal perforation, including abdominal Henoch-Schönlein purpura and peritonitis secondary to sepsis. However, these conditions are generally not associated with a large amount of free intraperitoneal air and are often accompanied by clinical clues to the underlying primary disease. Although ultrasonography is more sensitive for detecting very small amounts of free air and may indicate gastrointestinal perforation earlier in neonates [29], the imaging approach differs somewhat in older children and adults. In patients with suspected perforation of a hollow intra-abdominal viscus, plain abdominal radiography has limited sensitivity for small volumes of free intraperitoneal air; however, once subdiaphragmatic free air is identified, it remains highly valuable for the early recognition of gastrointestinal perforation and is the preferred initial imaging examination [30]. Its sensitivity for gastrointestinal perforation ranges from 50% to 70%, depending on the volume of free intraperitoneal air. In early perforation with only a small amount of free air, the detection rate is relatively low, whereas the radiographic findings become progressively clearer as the volume of free air increases [31]. In the present case, the upright abdominal radiograph demonstrated subdiaphragmatic free air, and this positive finding provided crucial evidence supporting the diagnosis. When perforation is strongly suspected clinically, computed tomography (CT) is the most sensitive imaging modality for evaluating suspected gastrointestinal perforation. With a reported localization accuracy of 82% to 90% for the perforated segment [32], CT serves as a key tool in preoperative assessment. In the present case, plain abdominal CT was therefore performed to identify the likely site of perforation before surgery and to provide useful guidance for laparoscopic planning. Notably, precise localization of the perforation is highly relevant to the choice of surgical approach and laparoscopic port placement. In this case, abdominal CT suggested gastric perforation, and a transumbilical laparoscopic exploration was therefore undertaken. In pediatric patients, perforation most commonly occurs along the greater curvature of the stomach, and the defect is often round in shape [3,5,13,15,17,24]. As the most distensible part of the gastric wall, the greater curvature may be particularly vulnerable to ischemic injury, which may in turn lead to perforation [5]. In the present case, intraoperative exploration confirmed a round perforation, consistent with previous reports. However, unlike most previously reported cases in older children, the perforation in our patient was located in the prepyloric region of the posterior gastric wall. This location is relatively concealed and represents an extremely uncommon pattern in adolescent SGP, with only rare reports in the domestic and international literature. Importantly, the site of perforation may substantially influence the difficulty of early recognition. Perforation of the anterior gastric wall tends to be recognized earlier because the larger peritoneal space and limited omental containment in children allow gastric contents and air to escape more freely, resulting in more obvious pneumoperitoneum on radiography and more prominent peritoneal signs. By contrast, perforation near the pylorus on the posterior wall may be temporarily contained by the lesser sac and surrounding structures, leading to less gas leakage and less typical peritoneal irritation, with abdominal pain as the main early manifestation and without obvious muscular guarding. This may increase the risk of missed or delayed diagnosis. Therefore, although spontaneous gastric perforation is rare, it should be included in the differential diagnosis when a child presents with unexplained diffuse peritonitis. 3.3 Laparoscopic surgical management and prognosis Spontaneous gastric perforation has an abrupt onset and is associated with a high mortality rate. Mortality has been reported to reach 30%-70% in neonates [33], and up to 30% in infants and children beyond the neonatal period [5]. This high mortality is related to the combined effects of chemical peritonitis, bacterial contamination of the peritoneal cavity by gastrointestinal flora, and the corrosive effects of gastric acid and pepsin. Postoperative or secondary sepsis and septic shock may further aggravate the clinical course, accelerating organ failure and ultimately leading to death [5,22]. Because pediatric acute abdomen can progress rapidly, children with suspected gastric perforation should undergo prompt surgical assessment and intervention before shock develops or infection becomes uncontrolled, in order to avoid the serious consequences of delayed treatment. Gastric perforation in children usually requires surgical management, and the choice of procedure depends on the underlying cause and the extent of tissue injury. For small perforations without obvious evidence of gastric wall ischemia or necrosis, primary closure is generally sufficient and can achieve satisfactory outcomes. When the perforation is large or the gastric wall is severely damaged, Graham patch repair or partial gastrectomy may be required to obtain an adequate therapeutic result [1,5,15]. Given the abrupt onset and high mortality of gastric perforation, laparoscopic exploration was performed immediately in this case once gastric perforation had been recognized early and strongly suspected. Intraoperatively, the perforation measured only 0.5 × 0.5 cm, and because the defect was small, primary suture closure was undertaken, with a favorable clinical outcome. During follow-up, the patient maintained good oral intake and nutritional status. In fact, laparoscopic exploration deserves wider application in the management of pediatric acute abdomen, as it can rapidly identify the site of pathology, assess the extent of injury, and allow definitive repair during the same procedure. Nevertheless, the surgical approach should still be selected cautiously according to the patient’s age, disease severity, degree of peritoneal contamination, and the surgeon’s experience. This case suggests that, for rare but high-risk pediatric surgical emergencies such as spontaneous gastric perforation, improvement in prognosis depends on decisive intervention based on early recognition, rather than delayed observation. 4 Conclusion Spontaneous gastric perforation in children is an uncommon yet rapidly progressive and potentially fatal cause of acute abdomen, for which early recognition and prompt intervention are pivotal to a favorable outcome. This case documents the successful treatment of spontaneous posterior gastric wall perforation in a 12-year-old adolescent girl, a presentation that remains only rarely reported in this age group in both the domestic and international literature and therefore carries particular clinical relevance. Beyond expanding the current clinical spectrum of pediatric spontaneous gastric perforation, this case underscores a critical diagnostic message: in children with acute abdominal pain of unclear origin, especially when accompanied by signs of peritonitis, clinicians should maintain a high index of suspicion and pursue timely imaging evaluation to secure the earliest possible diagnosis and intervention. By highlighting this rare entity, our report contributes meaningful evidence to the recognition and management of uncommon causes of pediatric acute abdomen and may help refine diagnostic and therapeutic strategies to improve outcomes and quality of life in affected children. Declarations Ethics approval and consent to participate This case report was approved by the Medical Ethics Committee of Shaoxing Women and Children’s Hospital (approval no. IRB-AF/37 − 2.0). Written informed consent for publication was obtained from the patient’s legal guardian. Competing interests The authors declare that they have no competing interests. Author Contribution L.S.S. drafted the main manuscript.L.E.Z. reviewed and revised the manuscript.W.J.L. critically revised the manuscript.L.S.S. and Y.L.H. performed the literature review and data curation.All authors reviewed and approved the final manuscript. Acknowledgements We sincerely thank the patient and her family for willingly sharing the clinical information for academic purposes and for maintaining ongoing communication with our team throughout the follow-up period. References Assefa G, Makuach B, Tabor BB, et al. Spontaneous gastric perforation in a 6-year-old child: a rare case report. Ann Med Surg (Lond). 2025;87(7):4672–5. 10.1097/MS9.0000000000003443 . Hashmi KS, Ellul T, Leopard DC, et al. Spontaneous gastric perforation in an 11-year-old boy with anorexia nervosa: rare presentation with right iliac fossa pain. BMJ Case Rep. 2012;2012:bcr–2012. 10.1136/bcr-2012-006512 . Akalonu A, Yasrebi M, Molle Rios Z. Spontaneous gastric perforation in two adolescents. Am J Case Rep. 2016;17:694–8. 10.12659/AJCR.898939 . Watanabe S, Matsudera S, Yamaguchi T, et al. Spontaneous gastric perforation in an adolescent with severe motor and intellectual disabilities: a case report. Dokkyo Med J. 2024;3(2):146–51. 10.51040/dkmj.2023-019 . Wang K, Cai S, He L, et al. Pediatric gastric perforation beyond neonatal period: 8-year experience with 20 patients. Pediatr Neonatol. 2019;60(6):634–40. 10.1016/j.pedneo.2019.03.006 . Ueda Y, Shindo H, Adachi N, et al. [A case of idiopathic gastric rupture in a 13-year-old adolescent]. 日臨外会誌. 2015;76(11):2724–8. 10.3919/jjsa.76.2724 . [in Japanese]. Ong HL, Lim X, Chan GME, et al. Identifying risk factors for neonatal gastric perforation: a scoping review and case series in a tertiary center. J Neonatol. 2026;40(2):179–92. 10.1177/09732179251337215 . Chen XH, Zhao QQ, Wei H, et al. [Retrospective study of the clinical characteristics of gastric perforation in 26 full-term neonates]. J Chongqing Med Univ. 2023;48(3):316–21. 10.13406/j.cnki.cyxb.003197 . [in Chinese]. Zhang S, Hou CZ, Shi W, et al. [Clinical analysis of 30 cases of gastrointestinal perforation caused by ingestion of magnetic foreign bodies in children]. Chin J Woman Child Health Res. 2021;32(11):1666–71. 10.3969/j.issn.1673-5293.2021.11.022 . [in Chinese]. Arnold M, Numanoglu A. Caustic ingestion in children—a review. Semin Pediatr Surg. 2017;26(2):95–104. 10.1053/j.sempedsurg.2017.02.002 . Ceylan H, Özokutan BH, Gündüz F, et al. Gastric perforation after corrosive ingestion. Pediatr Surg Int. 2011;27(6):649–53. 10.1007/s00383-010-2739-6 . Wang EH, Sun M. [Clinical analysis of 173 children with upper gastrointestinal ulcer]. Chin J Contemp Pediatr. 2022;24(4):372–6. 10.7499/j.issn.1008-8830.2201003 . [in Chinese]. Adachi Y, Takamatsu H, Noguchi H, et al. Spontaneous rupture of the stomach in preschool age children: a report of two cases. Surg Today. 1998;28(1):79–82. 10.1007/BF02483613 . Qin H. Gastric rupture caused by acute gastric distention in non-neonatal children: clinical analysis of 3 cases. Chin Med J (Engl). 2000;113(12):1147–9. 10.3760/cma.j.issn.0366-6999.2000.12.118 . Libeer F, Vanhamel N, Huyghe M, et al. Spontaneous gastric rupture in non-neonatal children: a case report. Acta Chir Belg. 2007;107(5):560–3. 10.1080/00015458.2007.11680124 . Schinasi DA, Ellison AM. Spontaneous gastric perforation in a child with heterotaxy syndrome. Pediatr Emerg Care. 2010;26(12):925–7. 10.1097/PEC.0b013e3181fe9175 . Prabhu VV, Prasadi S, Dhanawade S. Idiopathic spontaneous posterior gastric perforation in a preschool child—a rarity. J Postgrad Med Inst. 2013;27(1):108–10. No DOI available. Catania VD, Bonomo R, Gulia C, et al. Spontaneous gastric rupture in a 22-month-old boy: case report and review of the literature. J Pediatr Surg Case Rep. 2014;2(2):82–4. 10.1016/j.epsc.2014.01.010 . Salerno D, Raiola G, Francica I, et al. A case of spontaneous gastric rupture in a 5-year-old girl. Pediatr Med Chir. 2014;36(3):10. 10.4081/pmc.2014.10 . Wang XJ, Wang HL. [Spontaneous gastric rupture in a child: a case report]. Int Med Health Guidance News. 2017;23(5):734. 10.3760/cma.j.issn.1007-1245.2017.05.039 . [in Chinese]. You ZH, Xi HW, Shi ZF. [Clinical analysis of spontaneous gastric rupture in non-neonatal children]. Chin Pediatr Emerg Med. 2017;24(12):946–9. No DOI available. [in Chinese]. Misanovic V, Begic E. Spontaneous rupture of the stomach in nonneonatal period. Saudi Crit Care J. 2018;2(1):8. 10.4103/sccj.sccj_17_18 . Dhar PP, Dey A. A case of spontaneous gastric perforation in a 3-year-old male child. Int Surg J. 2022;9(7):1362. 10.18203/2349-2902.isj20221727 . Miyake K, Yoshida M, Matsuda R, et al. [A case of idiopathic gastric rupture in a preschool child]. 日小外会誌. 2024;60(4):702–7. 10.11164/jjsps.60.4_702 . [in Japanese]. Durak F, Kulluoglu EP, Ozcifci G et al. Spontaneous gastric rupture: a case of a toddler. J Pediatr Health Care. 2025:S0891-5245(25)00200-7. 10.1016/j.pedhc.2025.07.008 Huerta CT, Perez EA. Diagnosis and management of neonatal gastric perforation: a narrative review. Dig Med Res. 2022;5:27. 10.21037/dmr-21-105 . Jactel SN, Abramowsky CR, Schniederjan M, et al. Noniatrogenic neonatal gastric perforation: the role of interstitial cells of Cajal. Fetal Pediatr Pathol. 2013;32(6):422–8. 10.3109/15513815.2013.799248 . Karadayi K, Yildiz E, Turan M, et al. Gastric necrosis and perforation caused by acute gastric dilatation: report of a case. Surg Today. 2003;33(4):302–4. 10.1007/s005950300068 . Esposito F, Mamone R, Di Serafino M, et al. Diagnostic imaging features of necrotizing enterocolitis: a narrative review. Quant Imaging Med Surg. 2017;7(3):336–44. 10.21037/qims.2017.03.01 . Chen SC, Zhang MC. [Death due to gastric perforation caused by congenital muscular layer defect of the gastric wall in an infant: a case report]. J Forensic Med. 2023;39(6):612–3. 10.12116/j.issn.1004-5619.2023.430309 . [in Chinese]. Kulinna-Cosentini C, Hodge JC, Ba-Ssalamah A. The role of radiology in diagnosing gastrointestinal tract perforation. Best Pract Res Clin Gastroenterol. 2024;70:101928. 10.1016/j.bpg.2024.101928 . Terui K, Iwai J, Yamada S, et al. Etiology of neonatal gastric perforation: a review of 20 years' experience. Pediatr Surg Int. 2012;28(1):9–14. 10.1007/s00383-011-3003-4 . Tables Table 1 Reported cases of spontaneous gastric perforation in children older than 1 year (Cases 2, 11, 12, and 14 were reported from China). No. Publication year Author Country Age Sex Site of perforation Predisposing factors / underlying conditions Treatment Outcome Reference 1 1998 Adachi et al. Japan 2 y; 4 y F/F Posterior wall; one case had double perforations at the posterior fundus TOF in one case; prior gastric dilatation in one case Emergency laparotomy and primary repair Alive (both); uneventful postoperative recovery [ 13 ] 2 2000 Qin et al. China 3 cases (ages NR) NR NR Acute gastric dilatation was considered the most likely mechanism Individualized management; gastrostomy/supportive care in 2 cases, and no surgery in 1 case 1 Dead; 1 Alive with neurologic sequelae; 1 Alive with stable postoperative recovery [ 14 ] 3 2007 Libeer et al. Belgium 3 y F Anterior wall of the gastric body near the greater curvature Nausea and vomiting after a large meal; acute gastric dilatation was suspected Emergency laparotomy and sleeve gastrectomy Alive; survived after intensive postoperative monitoring [ 15 ] 4 2010 Schinasi et al. USA NR NR NR Heterotaxy syndrome Surgical repair Alive; detailed postoperative outcome not reported [ 16 ] 5 2013 Prabhu et al. India 3 y F Posterior wall of the gastric body near the greater curvature No evidence of NSAID use, steroid exposure, corrosive ingestion, or peptic ulcer; no definite trigger identified Primary suture repair, omental patch, and drainage Alive; uneventful recovery [ 17 ] 6 2014 Cataniaet al. Italy 22 mo M Gastric fundus and greater curvature; extensive rupture Nausea and vomiting after a large meal; acute dilatation/ischemia was suspected Emergency laparotomy and sleeve gastrectomy Alive; uncomplicated postoperative course [ 18 ] 7 2014 Salerno et al. Italy 5 y F Posterior wall No history of trauma or gastrointestinal disease; pathology showed muscular abnormality of the gastric wall Urgent gastrectomy Alive; favorable follow-up [ 19 ] 8 2015 Ueda et al. Japan 13 y F Anterior wall of the gastric fundus; two perforations No definite cause identified Resuscitative support; diagnosis confirmed at autopsy Dead; abrupt onset with shock, resuscitation unsuccessful [ 6 ] 9 2016 Akalonu et al. USA 11 y F Distal anterior stomach No definite cause; H. pylori negative; no ulcer or inflammation identified intraoperatively Laparoscopic repair with omental patch Alive; favorable follow-up [ 3 ] 10 2016 Akalonu et al. USA 15 y M Mid lesser curvature No definite cause; pathology showed no ulcer or inflammation Graham patch repair Alive; favorable short-term follow-up [ 3 ] 11 2017 Wang Xujie et al. China 5 y F NR Abdominal pain after overeating; similar episode 16 months earlier NR NR [ 20 ] 12 2017 You Zhiheng et al. China NR NR NR Only limited bibliographic information is publicly available NR NR [ 21 ] 13 2018 Misanovic et al. Bosnia and Herzegovina 3 y 3 mo F Exact site NR; multiple mucosal defects with transmural hemorrhage Acute gastric dilatation was suspected; previously healthy Emergency surgery within 6 h and PICU support Dead; peritonitis and sepsis, with intracranial hemorrhage reported [ 22 ] 14 2019 Wang et al. China 4.30 mo–14.17 y (20 cases) 6M/14F Multiple sites; greater curvature most commonly involved Various etiologies, with spontaneous perforation predominating Individualized surgical management 14 Alive and 6 Dead; most survivors had satisfactory quality of life, with 1 recurrent perforation and 3 neurologic sequelae [ 5 ] 15 2022 Dhar et al. India 3 y M Pyloric region Seizure disorder; long-term sodium valproate therapy; trigger unclear Laparotomy and modified Graham patch repair Alive; postoperative electrolyte disturbance and wound infection resolved [ 23 ] 16 2024 Miyake et al. Japan 5 y F Posterior wall near the greater curvature of the upper gastric body (3-cm defect) No prior medical history; rapidly progressive abdominal pain and nausea with shock Emergency laparotomy, primary closure, drainage, and PICU support Alive; discharged on POD 24 [ 24 ] 17 2024 Watanabe et al. Japan 15 y M NR Severe motor and intellectual disability, impaired peristalsis associated with antiepileptic therapy, malnutrition, and Candida albicans detected Emergency laparotomy, partial gastrectomy, and prolonged antifungal therapy Alive; discharged after 2 months [ 4 ] 18 2025 Assefa et al. Ethiopia 6 y F Prepyloric region No trauma, medication exposure, corrosive ingestion, or H. pylori infection; ischemic change on pathology Laparotomy and Graham omental patch repair Alive; discharged on POD 10 and asymptomatic at 3 months [ 1 ] 19 2025 Durak et al. Turkey 2 y F NR Previously healthy; presented with abdominal distension, vomiting, and constipation Surgery reported in the abstract; procedural details NR NR [ 25 ] F = female; M = male; NR = not reported; PICU = pediatric intensive care unit; POD = postoperative day; TOF = tetralogy of Fallot. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 05 May, 2026 Reviews received at journal 03 May, 2026 Reviewers agreed at journal 30 Apr, 2026 Reviewers agreed at journal 25 Apr, 2026 Reviews received at journal 22 Apr, 2026 Reviewers agreed at journal 16 Apr, 2026 Reviewers invited by journal 16 Apr, 2026 Editor invited by journal 16 Apr, 2026 Editor assigned by journal 15 Apr, 2026 Submission checks completed at journal 15 Apr, 2026 First submitted to journal 13 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9399435","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":627523241,"identity":"da4128a9-c2a5-4d17-9492-7a9d5aa78cff","order_by":0,"name":"Lisong Shao","email":"","orcid":"","institution":"Shaoxing Maternity and Child Healthcare Hospital","correspondingAuthor":false,"prefix":"","firstName":"Lisong","middleName":"","lastName":"Shao","suffix":""},{"id":627523242,"identity":"83a362a2-ff1b-4461-af50-160b7f2f1e19","order_by":1,"name":"Lian’en Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYDACCRBRACYZHzDwgOgEYrQYgElmA1K0gJlsEhAhAlrkZzc/e/jFwELenL33WOUPmcMM/Ow5Bgw/d+DWwjjnmLmxjIGE4c6ec2k3JHgOM0j2vDFg7D2DWwuzRIKZtISBBOOGGzlmNwyAWgxu5BgwM7bh1sImkf4NpMV+w/03ZgUJQC32hLTwSOSYSX4wkEjccIPHjOEAyBYJAlokJHLKpIHKkjecyTGWbOBJ55E486zgYC8eLfIz0rdJ/qios91w/Izhx5891nL87ckbH/zEowUcBDwwFmMPJDIP4NcAVPgDzvyBR9koGAWjYBSMWAAAl11JXpurikkAAAAASUVORK5CYII=","orcid":"","institution":"Operating Room, Shaoxing People’s Hospital","correspondingAuthor":true,"prefix":"","firstName":"Lian’en","middleName":"","lastName":"Zhang","suffix":""},{"id":627523243,"identity":"18cc8f06-a088-4a69-9b21-e60337a3b004","order_by":2,"name":"Weijun Li","email":"","orcid":"","institution":"Shaoxing Maternity and Child Healthcare Hospital","correspondingAuthor":false,"prefix":"","firstName":"Weijun","middleName":"","lastName":"Li","suffix":""},{"id":627523244,"identity":"5c4586e0-3810-4011-b553-e6ac6f16979a","order_by":3,"name":"Yuanlong Han","email":"","orcid":"","institution":"Shaoxing Maternity and Child Healthcare Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yuanlong","middleName":"","lastName":"Han","suffix":""}],"badges":[],"createdAt":"2026-04-13 06:23:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9399435/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9399435/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107834665,"identity":"794ac5b9-d196-4cd9-abdd-140eeb5646d9","added_by":"auto","created_at":"2026-04-26 15:46:46","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":41345,"visible":true,"origin":"","legend":"\u003cp\u003eUpright abdominal radiograph showing a large amount of free air beneath both hemidiaphragms (arrows), suggestive of gastrointestinal perforation.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9399435/v1/3e01cca601d1dd9b11f28a2e.jpeg"},{"id":107834666,"identity":"cc687de2-a61b-4144-a1f4-8c0a20d1ad78","added_by":"auto","created_at":"2026-04-26 15:46:46","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":35295,"visible":true,"origin":"","legend":"\u003cp\u003eAbdominal computed tomography showing a large amount of free intraperitoneal air (arrows), consistent with gastrointestinal perforation with diffuse peritonitis.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9399435/v1/e889bae7ac0f0ee5bd3d3723.jpeg"},{"id":107834667,"identity":"100af55f-6483-4541-ae17-289b9cdcb0df","added_by":"auto","created_at":"2026-04-26 15:46:46","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":28500,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative laparoscopic view showing a round perforation in the prepyloric region of the posterior gastric wall (arrow).\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9399435/v1/83fccb5afe2b6787bd8f223b.jpeg"},{"id":107869981,"identity":"bcfd6a12-5ee0-48c8-9ac0-431c1ff19c94","added_by":"auto","created_at":"2026-04-27 07:38:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":405133,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9399435/v1/38b94ce7-6855-4371-b889-9d1e8aee82b9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Spontaneous Gastric Perforation in a 12-Year-Old Adolescent Girl: A Case Report and Literature Review","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eSpontaneous gastric perforation (SGP) is a rare but life-threatening surgical emergency. It is more common in the neonatal period and has occasionally been reported in adults[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], but is uncommon in older children and only rarely reported in post-school-age children and adolescents [\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. SGP typically has an abrupt onset and lacks specific clinical features, and its early manifestations often overlap with those of other causes of acute abdomen, making misdiagnosis and delayed treatment common. If diagnosis and intervention are not achieved promptly, leakage of gastric contents can rapidly lead to diffuse peritonitis, sepsis, shock, and multiple organ dysfunction, markedly increasing the risk of death and adversely affecting both short-term recovery and long-term prognosis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Although SGP has been relatively well documented in neonates, where it is frequently associated with congenital gastrointestinal malformations or developmental defects of the gastric wall [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], its occurrence in post-school-age children and adolescents remains poorly characterized. Critically, the available domestic and international literature in this age group is still extremely limited and consists mainly of isolated case reports [\u003cspan additionalcitationids=\"CR3 CR4 CR5\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In contrast, gastric perforation in children is more often attributable to identifiable causes, such as trauma, peptic ulcer disease, corrosive ingestion, accidental ingestion of magnetic beads, medication exposure (e.g., nonsteroidal anti-inflammatory drugs or corticosteroids), or stress-related injury [\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This striking lack of evidence highlights a clear gap in current knowledge regarding the recognition and management of SGP in older pediatric patients. Here, we report a case of spontaneous gastric perforation in a 12-year-old adolescent girl, representing a rarely reported presentation in the adolescent age group in both the domestic and international literature, who was successfully treated. We focus on the clinical presentation, imaging findings, diagnostic process, and surgical management. By integrating this case with a review of the domestic and international literature, we aim to improve awareness of SGP in pediatric acute abdomen, evaluate the clinical value of minimally invasive surgery in children with SGP, and provide evidence to inform clinical practice.\u003c/p\u003e"},{"header":"2 Case presentation","content":"\u003cp\u003eA 12-year- and 6-month-old girl was brought to the emergency department of our hospital by her parents on October 17, 2025, with a 5-hour history of abdominal pain. She reported the sudden onset of marked epigastric pain, accompanied by fatigue and poor appetite. The pain subsequently became diffuse and involved the entire abdomen, and she assumed an antalgic posture. She also experienced multiple episodes of non-projectile vomiting consisting mainly of gastric contents without bile. She had no diarrhea, urinary frequency, or urinary urgency. On physical examination, her body temperature was 37.6\u0026deg;C. Abdominal distension was present, with mild abdominal muscle guarding. No abnormal mass was palpable. Deep tenderness was noted throughout the abdomen, while rebound tenderness was not elicited in the right lower quadrant. Bowel sounds were decreased. Detailed history taking from both the patient and her guardians confirmed that she had previously been in good health, with no relevant family history, no prior episodes of abdominal pain, and no recent history of trauma, foreign body ingestion, medication use, or corrosive substance ingestion. There was also no history of binge eating before symptom onset. An upright abdominal radiograph obtained in the emergency department showed a large amount of free air beneath both hemidiaphragms, raising strong suspicion of gastrointestinal perforation (Fig. \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). To further clarify the diagnosis, abdominal computed tomography was performed immediately and demonstrated a large volume of free intraperitoneal air (Fig. \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), consistent with gastrointestinal perforation with diffuse peritonitis. The preliminary diagnosis was gastrointestinal perforation with acute diffuse peritonitis.\u003c/p\u003e\n\u003cp\u003eFollowing admission, the patient immediately underwent laboratory investigations, including complete blood count, coagulation profile, liver and renal function tests, and screening for infectious diseases. However, the white blood cell count and C-reactive protein level were only mildly elevated and not markedly abnormal. No contraindications to surgery were identified. One hour after emergency admission, she underwent laparoscopic exploration under general anesthesia. Prophylactic antibiotics were administered 30 minutes before surgery. Pneumoperitoneum was established through one 5-mm periumbilical incision and two 3-mm working ports. Intraoperatively, a 0.5 \u0026times; 0.5 cm round perforation was identified in the prepyloric region of the posterior gastric wall. No ulcer scar was seen around the perforation, and no abnormalities were found in the remainder of the stomach or in other intra-abdominal organs. A small amount of purulent exudate was present in the peritoneal cavity (Fig. \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The perforation was repaired laparoscopically with a two-layer suture closure, and the repair was reinforced by coverage with the greater omentum. After peritoneal irrigation, a nasogastric tube was placed and the abdomen was closed. The procedure was completed uneventfully, with an operative time of 90 minutes and an estimated blood loss of approximately 3 mL.\u003c/p\u003e\n\u003cp\u003eOn postoperative day 1, a ^13C urea breath test for Helicobacter pylori was performed and was negative. The postoperative course was uneventful. The patient received ceftriaxone for anti-infective therapy and omeprazole for acid suppression and gastric protection. She was kept nil per os for 2 days with intravenous fluid support, resumed a liquid diet on postoperative day 3, and had the nasogastric tube removed the same day. She was discharged on postoperative day 5. Based on the clinical presentation, medical history, and examination findings, the final postoperative diagnosis was spontaneous gastric perforation in a child. At follow-up 1 week, 1 month, and 2 months after discharge, she remained well, with no abdominal pain or other gastrointestinal symptoms, and had returned to school and normal physical activity.\u003c/p\u003e\n\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThis case report was approved by the Medical Ethics Committee of Shaoxing Women and Children\u0026rsquo;s Hospital (approval no. IRB-AF/37-2.0). Written informed consent for publication was obtained from the patient\u0026rsquo;s legal guardian.\u003c/p\u003e"},{"header":"3 Discussion","content":"\u003ch3\u003e3.1 Rarity and possible mechanisms\u003c/h3\u003e\n\u003cp\u003eSpontaneous gastric perforation (SGP) is only rarely reported in older children, particularly in adolescents [6,3-5]. Our literature review (Table 1) showed that reported cases of spontaneous gastric perforation beyond 1 year of age remain scarce and consist mainly of isolated case reports and small retrospective studies. Most reported patients were infants or preschool-aged children, and a substantial proportion of cases were fatal [3-6,22]. In contrast, successfully treated cases in adolescents, such as the present case, have been only sporadically reported in the domestic and international literature [3,4]. Precisely because of its rarity, SGP is easily overlooked in clinical practice, where limited diagnostic suspicion and insufficient awareness may delay recognition and treatment, allowing rapid progression to diffuse peritonitis, septic shock, and even death [5,6,22]. Nevertheless, the epidemiological characteristics and pathogenesis of SGP remain poorly defined. Previous reports have suggested a relative predominance of female patients, and a similar pattern has also been observed in preschool-aged children [5].However, this single case should be regarded only as an additional clinical observation, as the currently available evidence is derived from extremely small samples and remains insufficient to support a definite sex predilection for this condition. The risk factors for spontaneous neonatal gastric perforation (SNGP) have been more extensively discussed and are commonly associated with perinatal asphyxia, excessive mechanical ventilation, prematurity with low birth weight, and prolonged corticosteroid exposure. Other proposed factors include incomplete embryonic development, structural abnormalities of the gastric wall, and a reduced number of interstitial cells of Cajal (ICC) [7,8,26,27]. By contrast, gastric perforation in older children and adults is usually secondary to identifiable causes, such as trauma, corrosive ingestion, gastric ulceration, gastric tuberculosis, \u003cem\u003eHelicobacter pylori\u003c/em\u003e infection, or Burkitt lymphoma during chemotherapy [9,11,12]. In pediatric SGP, increased intragastric pressure has been considered one of the most important potential risk factors. Previous case reports have suggested that binge eating, or rapid ingestion of a large amount of food in patients with Prader–Willi syndrome, may result in marked elevation of intragastric pressure and acute gastric dilatation [14,15,18,28]. It has been reported that when intragastric pressure exceeds 30 cm H₂O, venous return may be compromised, leading to ischemia of the gastric wall and, ultimately, perforation\u0026nbsp;[28]. In addition, underlying conditions such as seizures and neurological disorders have also been implicated in some cases, possibly through gastric wall injury or disordered gastrointestinal motility\u0026nbsp;[4,23]. In the present case, the patient had no family history, no history of trauma, no prior chronic abdominal pain, and no history of medication use. She had not ingested a foreign body or corrosive substance, tested negative for \u003cem\u003eH. pylori\u003c/em\u003e, and showed no intraoperative evidence of peptic ulcer disease or neoplastic lesions. Furthermore, she had no other obvious stress-related triggers and did not exhibit any clinical features suggestive of Prader-Willi syndrome, findings that are highly consistent with those reported in previous case reports.\u0026nbsp;Therefore, in adolescent patients presenting with acute abdomen, especially girls, spontaneous gastric perforation should be included in the differential diagnosis in addition to more common conditions such as appendicitis, gynecological emergencies, intestinal perforation, and intestinal obstruction.\u0026nbsp;This case broadens the age spectrum of pediatric SGP by adding evidence from adolescence and further suggests that spontaneous gastric perforation may occur even in the absence of typical high-risk factors. As such, it may provide a useful clinical reference for improving recognition of this condition and deepening understanding of its possible mechanisms.\u003c/p\u003e\n\u003ch3\u003e3.2 Imaging features and early diagnosis\u003c/h3\u003e\n\u003cp\u003eThe clinical manifestations of spontaneous gastric perforation in children are nonspecific and usually include abdominal pain, abdominal distension, vomiting, and dyspnea [5,22,23]. The typical presentation is the sudden onset of severe abdominal pain accompanied by signs of peritonitis. However, younger children often have limited ability to localize or accurately describe pain, making this condition easily confused with other causes of acute abdomen. In the present case, the patient’s sudden epigastric pain rapidly progressed to generalized abdominal pain and was accompanied by low-grade fever, poor appetite, abdominal distension, and repeated non-projectile vomiting, all of which strongly suggested perforation of an intra-abdominal viscus. In addition, diffuse abdominal tenderness in children may also occur in conditions other than gastrointestinal perforation, including abdominal Henoch-Schönlein purpura and peritonitis secondary to sepsis. However, these conditions are generally not associated with a large amount of free intraperitoneal air and are often accompanied by clinical clues to the underlying primary disease. Although ultrasonography is more sensitive for detecting very small amounts of free air and may indicate gastrointestinal perforation earlier in neonates [29], the imaging approach differs somewhat in older children and adults. In patients with suspected perforation of a hollow intra-abdominal viscus, plain abdominal radiography has limited sensitivity for small volumes of free intraperitoneal air; however, once subdiaphragmatic free air is identified, it remains highly valuable for the early recognition of gastrointestinal perforation and is the preferred initial imaging examination [30]. Its sensitivity for gastrointestinal perforation ranges from 50% to 70%, depending on the volume of free intraperitoneal air. In early perforation with only a small amount of free air, the detection rate is relatively low, whereas the radiographic findings become progressively clearer as the volume of free air increases\u0026nbsp;[31]. In the present case, the upright abdominal radiograph demonstrated subdiaphragmatic free air, and this positive finding provided crucial evidence supporting the diagnosis. When perforation is strongly suspected clinically, computed tomography (CT) is the most sensitive imaging modality for evaluating suspected gastrointestinal perforation. With a reported localization accuracy of 82% to 90% for the perforated segment\u0026nbsp;[32], CT serves as a key tool in preoperative assessment. In the present case, plain abdominal CT was therefore performed to identify the likely site of perforation before surgery and to provide useful guidance for laparoscopic planning. Notably, precise localization of the perforation is highly relevant to the choice of surgical approach and laparoscopic port placement. In this case, abdominal CT suggested gastric perforation, and a transumbilical laparoscopic exploration was therefore undertaken. In pediatric patients, perforation most commonly occurs along the greater curvature of the stomach, and the defect is often round in shape\u0026nbsp;[3,5,13,15,17,24]. As the most distensible part of the gastric wall, the greater curvature may be particularly vulnerable to ischemic injury, which may in turn lead to perforation\u0026nbsp;[5]. In the present case, intraoperative exploration confirmed a round perforation, consistent with previous reports. However, unlike most previously reported cases in older children, the perforation in our patient was located in the prepyloric region of the posterior gastric wall. This location is relatively concealed and represents an extremely uncommon pattern in adolescent SGP, with only rare reports in the domestic and international literature. Importantly, the site of perforation may substantially influence the difficulty of early recognition. Perforation of the anterior gastric wall tends to be recognized earlier because the larger peritoneal space and limited omental containment in children allow gastric contents and air to escape more freely, resulting in more obvious pneumoperitoneum on radiography and more prominent peritoneal signs. By contrast, perforation near the pylorus on the posterior wall may be temporarily contained by the lesser sac and surrounding structures, leading to less gas leakage and less typical peritoneal irritation, with abdominal pain as the main early manifestation and without obvious muscular guarding. This may increase the risk of missed or delayed diagnosis. Therefore, although spontaneous gastric perforation is rare, it should be included in the differential diagnosis when a child presents with unexplained diffuse peritonitis.\u003c/p\u003e\n\u003ch3\u003e3.3 Laparoscopic surgical management and prognosis\u003c/h3\u003e\n\u003cp\u003eSpontaneous gastric perforation has an abrupt onset and is associated with a high mortality rate. Mortality has been reported to reach 30%-70% in neonates [33], and up to 30% in infants and children beyond the neonatal period [5]. This high mortality is related to the combined effects of chemical peritonitis, bacterial contamination of the peritoneal cavity by gastrointestinal flora, and the corrosive effects of gastric acid and pepsin. Postoperative or secondary sepsis and septic shock may further aggravate the clinical course, accelerating organ failure and ultimately leading to death [5,22]. Because pediatric acute abdomen can progress rapidly, children with suspected gastric perforation should undergo prompt surgical assessment and intervention before shock develops or infection becomes uncontrolled, in order to avoid the serious consequences of delayed treatment. Gastric perforation in children usually requires surgical management, and the choice of procedure depends on the underlying cause and the extent of tissue injury. For small perforations without obvious evidence of gastric wall ischemia or necrosis, primary closure is generally sufficient and can achieve satisfactory outcomes. When the perforation is large or the gastric wall is severely damaged, Graham patch repair or partial gastrectomy may be required to obtain an adequate therapeutic result [1,5,15]. Given the abrupt onset and high mortality of gastric perforation, laparoscopic exploration was performed immediately in this case once gastric perforation had been recognized early and strongly suspected. Intraoperatively, the perforation measured only 0.5 × 0.5 cm, and because the defect was small, primary suture closure was undertaken, with a favorable clinical outcome. During follow-up, the patient maintained good oral intake and nutritional status. In fact, laparoscopic exploration deserves wider application in the management of pediatric acute abdomen, as it can rapidly identify the site of pathology, assess the extent of injury, and allow definitive repair during the same procedure. Nevertheless, the surgical approach should still be selected cautiously according to the patient’s age, disease severity, degree of peritoneal contamination, and the surgeon’s experience. This case suggests that, for rare but high-risk pediatric surgical emergencies such as spontaneous gastric perforation, improvement in prognosis depends on decisive intervention based on early recognition, rather than delayed observation.\u003c/p\u003e"},{"header":"4 Conclusion","content":"\u003cp\u003eSpontaneous gastric perforation in children is an uncommon yet rapidly progressive and potentially fatal cause of acute abdomen, for which early recognition and prompt intervention are pivotal to a favorable outcome. This case documents the successful treatment of spontaneous posterior gastric wall perforation in a 12-year-old adolescent girl, a presentation that remains only rarely reported in this age group in both the domestic and international literature and therefore carries particular clinical relevance. Beyond expanding the current clinical spectrum of pediatric spontaneous gastric perforation, this case underscores a critical diagnostic message: in children with acute abdominal pain of unclear origin, especially when accompanied by signs of peritonitis, clinicians should maintain a high index of suspicion and pursue timely imaging evaluation to secure the earliest possible diagnosis and intervention. By highlighting this rare entity, our report contributes meaningful evidence to the recognition and management of uncommon causes of pediatric acute abdomen and may help refine diagnostic and therapeutic strategies to improve outcomes and quality of life in affected children.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003eThis case report was approved by the Medical Ethics Committee of Shaoxing Women and Children\u0026rsquo;s Hospital (approval no. IRB-AF/37\u0026thinsp;\u0026minus;\u0026thinsp;2.0). Written informed consent for publication was obtained from the patient\u0026rsquo;s legal guardian.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eL.S.S. drafted the main manuscript.L.E.Z. reviewed and revised the manuscript.W.J.L. critically revised the manuscript.L.S.S. and Y.L.H. performed the literature review and data curation.All authors reviewed and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWe sincerely thank the patient and her family for willingly sharing the clinical information for academic purposes and for maintaining ongoing communication with our team throughout the follow-up period.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAssefa G, Makuach B, Tabor BB, et al. Spontaneous gastric perforation in a 6-year-old child: a rare case report. Ann Med Surg (Lond). 2025;87(7):4672\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/MS9.0000000000003443\u003c/span\u003e\u003cspan address=\"10.1097/MS9.0000000000003443\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHashmi KS, Ellul T, Leopard DC, et al. Spontaneous gastric perforation in an 11-year-old boy with anorexia nervosa: rare presentation with right iliac fossa pain. BMJ Case Rep. 2012;2012:bcr\u0026ndash;2012. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bcr-2012-006512\u003c/span\u003e\u003cspan address=\"10.1136/bcr-2012-006512\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkalonu A, Yasrebi M, Molle Rios Z. Spontaneous gastric perforation in two adolescents. Am J Case Rep. 2016;17:694\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.12659/AJCR.898939\u003c/span\u003e\u003cspan address=\"10.12659/AJCR.898939\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatanabe S, Matsudera S, Yamaguchi T, et al. Spontaneous gastric perforation in an adolescent with severe motor and intellectual disabilities: a case report. Dokkyo Med J. 2024;3(2):146\u0026ndash;51. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.51040/dkmj.2023-019\u003c/span\u003e\u003cspan address=\"10.51040/dkmj.2023-019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang K, Cai S, He L, et al. Pediatric gastric perforation beyond neonatal period: 8-year experience with 20 patients. Pediatr Neonatol. 2019;60(6):634\u0026ndash;40. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.pedneo.2019.03.006\u003c/span\u003e\u003cspan address=\"10.1016/j.pedneo.2019.03.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUeda Y, Shindo H, Adachi N, et al. [A case of idiopathic gastric rupture in a 13-year-old adolescent]. 日臨外会誌. 2015;76(11):2724\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3919/jjsa.76.2724\u003c/span\u003e\u003cspan address=\"10.3919/jjsa.76.2724\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [in Japanese].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOng HL, Lim X, Chan GME, et al. Identifying risk factors for neonatal gastric perforation: a scoping review and case series in a tertiary center. J Neonatol. 2026;40(2):179\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/09732179251337215\u003c/span\u003e\u003cspan address=\"10.1177/09732179251337215\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen XH, Zhao QQ, Wei H, et al. [Retrospective study of the clinical characteristics of gastric perforation in 26 full-term neonates]. J Chongqing Med Univ. 2023;48(3):316\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.13406/j.cnki.cyxb.003197\u003c/span\u003e\u003cspan address=\"10.13406/j.cnki.cyxb.003197\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [in Chinese].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang S, Hou CZ, Shi W, et al. [Clinical analysis of 30 cases of gastrointestinal perforation caused by ingestion of magnetic foreign bodies in children]. Chin J Woman Child Health Res. 2021;32(11):1666\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3969/j.issn.1673-5293.2021.11.022\u003c/span\u003e\u003cspan address=\"10.3969/j.issn.1673-5293.2021.11.022\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [in Chinese].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArnold M, Numanoglu A. Caustic ingestion in children\u0026mdash;a review. Semin Pediatr Surg. 2017;26(2):95\u0026ndash;104. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1053/j.sempedsurg.2017.02.002\u003c/span\u003e\u003cspan address=\"10.1053/j.sempedsurg.2017.02.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCeylan H, \u0026Ouml;zokutan BH, G\u0026uuml;nd\u0026uuml;z F, et al. Gastric perforation after corrosive ingestion. Pediatr Surg Int. 2011;27(6):649\u0026ndash;53. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00383-010-2739-6\u003c/span\u003e\u003cspan address=\"10.1007/s00383-010-2739-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang EH, Sun M. [Clinical analysis of 173 children with upper gastrointestinal ulcer]. Chin J Contemp Pediatr. 2022;24(4):372\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7499/j.issn.1008-8830.2201003\u003c/span\u003e\u003cspan address=\"10.7499/j.issn.1008-8830.2201003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [in Chinese].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdachi Y, Takamatsu H, Noguchi H, et al. Spontaneous rupture of the stomach in preschool age children: a report of two cases. Surg Today. 1998;28(1):79\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/BF02483613\u003c/span\u003e\u003cspan address=\"10.1007/BF02483613\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQin H. Gastric rupture caused by acute gastric distention in non-neonatal children: clinical analysis of 3 cases. Chin Med J (Engl). 2000;113(12):1147\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3760/cma.j.issn.0366-6999.2000.12.118\u003c/span\u003e\u003cspan address=\"10.3760/cma.j.issn.0366-6999.2000.12.118\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLibeer F, Vanhamel N, Huyghe M, et al. Spontaneous gastric rupture in non-neonatal children: a case report. Acta Chir Belg. 2007;107(5):560\u0026ndash;3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/00015458.2007.11680124\u003c/span\u003e\u003cspan address=\"10.1080/00015458.2007.11680124\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchinasi DA, Ellison AM. Spontaneous gastric perforation in a child with heterotaxy syndrome. Pediatr Emerg Care. 2010;26(12):925\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/PEC.0b013e3181fe9175\u003c/span\u003e\u003cspan address=\"10.1097/PEC.0b013e3181fe9175\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrabhu VV, Prasadi S, Dhanawade S. Idiopathic spontaneous posterior gastric perforation in a preschool child\u0026mdash;a rarity. J Postgrad Med Inst. 2013;27(1):108\u0026ndash;10. No DOI available.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCatania VD, Bonomo R, Gulia C, et al. Spontaneous gastric rupture in a 22-month-old boy: case report and review of the literature. J Pediatr Surg Case Rep. 2014;2(2):82\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.epsc.2014.01.010\u003c/span\u003e\u003cspan address=\"10.1016/j.epsc.2014.01.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalerno D, Raiola G, Francica I, et al. A case of spontaneous gastric rupture in a 5-year-old girl. Pediatr Med Chir. 2014;36(3):10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4081/pmc.2014.10\u003c/span\u003e\u003cspan address=\"10.4081/pmc.2014.10\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang XJ, Wang HL. [Spontaneous gastric rupture in a child: a case report]. Int Med Health Guidance News. 2017;23(5):734. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3760/cma.j.issn.1007-1245.2017.05.039\u003c/span\u003e\u003cspan address=\"10.3760/cma.j.issn.1007-1245.2017.05.039\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [in Chinese].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYou ZH, Xi HW, Shi ZF. [Clinical analysis of spontaneous gastric rupture in non-neonatal children]. Chin Pediatr Emerg Med. 2017;24(12):946\u0026ndash;9. No DOI available. [in Chinese].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMisanovic V, Begic E. Spontaneous rupture of the stomach in nonneonatal period. Saudi Crit Care J. 2018;2(1):8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/sccj.sccj_17_18\u003c/span\u003e\u003cspan address=\"10.4103/sccj.sccj_17_18\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDhar PP, Dey A. A case of spontaneous gastric perforation in a 3-year-old male child. Int Surg J. 2022;9(7):1362. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.18203/2349-2902.isj20221727\u003c/span\u003e\u003cspan address=\"10.18203/2349-2902.isj20221727\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiyake K, Yoshida M, Matsuda R, et al. [A case of idiopathic gastric rupture in a preschool child]. 日小外会誌. 2024;60(4):702\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.11164/jjsps.60.4_702\u003c/span\u003e\u003cspan address=\"10.11164/jjsps.60.4_702\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [in Japanese].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDurak F, Kulluoglu EP, Ozcifci G et al. Spontaneous gastric rupture: a case of a toddler. J Pediatr Health Care. 2025:S0891-5245(25)00200-7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.pedhc.2025.07.008\u003c/span\u003e\u003cspan address=\"10.1016/j.pedhc.2025.07.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuerta CT, Perez EA. Diagnosis and management of neonatal gastric perforation: a narrative review. Dig Med Res. 2022;5:27. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21037/dmr-21-105\u003c/span\u003e\u003cspan address=\"10.21037/dmr-21-105\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJactel SN, Abramowsky CR, Schniederjan M, et al. Noniatrogenic neonatal gastric perforation: the role of interstitial cells of Cajal. Fetal Pediatr Pathol. 2013;32(6):422\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3109/15513815.2013.799248\u003c/span\u003e\u003cspan address=\"10.3109/15513815.2013.799248\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaradayi K, Yildiz E, Turan M, et al. Gastric necrosis and perforation caused by acute gastric dilatation: report of a case. Surg Today. 2003;33(4):302\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s005950300068\u003c/span\u003e\u003cspan address=\"10.1007/s005950300068\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEsposito F, Mamone R, Di Serafino M, et al. Diagnostic imaging features of necrotizing enterocolitis: a narrative review. Quant Imaging Med Surg. 2017;7(3):336\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21037/qims.2017.03.01\u003c/span\u003e\u003cspan address=\"10.21037/qims.2017.03.01\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen SC, Zhang MC. [Death due to gastric perforation caused by congenital muscular layer defect of the gastric wall in an infant: a case report]. J Forensic Med. 2023;39(6):612\u0026ndash;3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.12116/j.issn.1004-5619.2023.430309\u003c/span\u003e\u003cspan address=\"10.12116/j.issn.1004-5619.2023.430309\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [in Chinese].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKulinna-Cosentini C, Hodge JC, Ba-Ssalamah A. The role of radiology in diagnosing gastrointestinal tract perforation. Best Pract Res Clin Gastroenterol. 2024;70:101928. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.bpg.2024.101928\u003c/span\u003e\u003cspan address=\"10.1016/j.bpg.2024.101928\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTerui K, Iwai J, Yamada S, et al. Etiology of neonatal gastric perforation: a review of 20 years' experience. Pediatr Surg Int. 2012;28(1):9\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00383-011-3003-4\u003c/span\u003e\u003cspan address=\"10.1007/s00383-011-3003-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv id=\"10\" class=\"btn-xs-small Annotation tooltipped\" data-position=\"top\" data-tooltip=\"\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eReported cases of spontaneous gastric perforation in children older than 1 year (Cases 2, 11, 12, and 14 were reported from China).\u003c/div\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNo.\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePublication\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eyear\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAuthor\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eCountry\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAge\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eSex\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eSite of perforation\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePredisposing factors / underlying conditions\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eTreatment\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eOutcome\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eReference\u003c/div\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1998\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAdachi et al.\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eJapan\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2 y; 4 y\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eF/F\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePosterior wall; one case had double perforations at the posterior fundus\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eTOF in one case; prior gastric dilatation in one case\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eEmergency laparotomy and primary repair\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAlive (both); uneventful postoperative recovery\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e[\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2000\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eQin et al.\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eChina\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e3 cases\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003e(ages NR)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNR\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNR\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAcute gastric dilatation was considered the most likely mechanism\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eIndividualized management; gastrostomy/supportive care in 2 cases, and no surgery in 1 case\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1 Dead; 1 Alive with neurologic sequelae; 1 Alive with stable postoperative recovery\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e3\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2007\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eLibeer et al.\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eBelgium\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e3 y\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eF\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAnterior wall of the gastric body near the greater curvature\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNausea and vomiting after a large meal; acute gastric dilatation was suspected\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eEmergency laparotomy and sleeve gastrectomy\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAlive; survived after intensive postoperative monitoring\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e[\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e4\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2010\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eSchinasi et al.\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eUSA\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNR\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNR\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNR\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eHeterotaxy syndrome\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eSurgical repair\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAlive; detailed postoperative outcome not reported\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e[\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e5\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2013\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePrabhu et al.\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eIndia\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e3 y\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eF\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePosterior wall of the gastric body near the greater curvature\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNo evidence of NSAID use, steroid exposure, corrosive ingestion, or peptic ulcer; no definite trigger identified\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePrimary suture repair, omental patch, and drainage\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAlive; uneventful recovery\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e[\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e6\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2014\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eCataniaet al.\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eItaly\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e22 mo\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eM\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eGastric fundus and greater curvature; extensive rupture\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNausea and vomiting after a large meal; acute dilatation/ischemia was suspected\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eEmergency laparotomy and sleeve gastrectomy\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAlive; uncomplicated postoperative course\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e[\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e7\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2014\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eSalerno et al.\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eItaly\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e5 y\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eF\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePosterior wall\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNo history of trauma or gastrointestinal disease; pathology showed muscular abnormality of the gastric wall\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eUrgent gastrectomy\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAlive; favorable follow-up\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e[\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e8\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2015\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eUeda et al.\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eJapan\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e13 y\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eF\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAnterior wall of the gastric fundus; two perforations\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNo definite cause identified\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eResuscitative support; diagnosis confirmed at autopsy\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eDead; abrupt onset with shock, resuscitation unsuccessful\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e[\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e9\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2016\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAkalonu et al.\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eUSA\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e11 y\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eF\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eDistal anterior stomach\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNo definite cause; H. pylori negative; no ulcer or inflammation identified intraoperatively\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eLaparoscopic repair with omental patch\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAlive; favorable follow-up\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e[\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2016\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAkalonu et al.\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eUSA\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e15 y\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eM\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMid lesser curvature\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNo definite cause; pathology showed no ulcer or inflammation\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eGraham patch repair\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAlive; favorable short-term follow-up\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e[\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e11\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2017\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eWang Xujie et al.\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eChina\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e5 y\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eF\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNR\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAbdominal pain after overeating; similar episode 16 months earlier\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNR\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNR\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e[\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e12\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2017\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eYou Zhiheng et al.\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eChina\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNR\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNR\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNR\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eOnly limited bibliographic information is publicly available\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNR\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNR\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e[\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e13\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2018\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMisanovic et al.\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eBosnia and Herzegovina\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e3 y 3 mo\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eF\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eExact site NR; multiple mucosal defects with transmural hemorrhage\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAcute gastric dilatation was suspected; previously healthy\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eEmergency surgery within 6 h and PICU support\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eDead; peritonitis and sepsis, with intracranial hemorrhage reported\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e[\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e14\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2019\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eWang et al.\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eChina\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e4.30 mo\u0026ndash;14.17 y (20 cases)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e6M/14F\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMultiple sites; greater curvature most commonly involved\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eVarious etiologies, with spontaneous perforation predominating\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eIndividualized surgical management\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e14 Alive and 6 Dead; most survivors had satisfactory quality of life, with 1 recurrent perforation and 3 neurologic sequelae\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e[\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e15\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2022\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eDhar et al.\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eIndia\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e3 y\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eM\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePyloric region\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eSeizure disorder; long-term sodium valproate therapy; trigger unclear\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eLaparotomy and modified Graham patch repair\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAlive; postoperative electrolyte disturbance and wound infection resolved\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e[\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e16\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2024\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMiyake et al.\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eJapan\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e5 y\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eF\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePosterior wall near the greater curvature of the upper gastric body (3-cm defect)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNo prior medical history; rapidly progressive abdominal pain and nausea with shock\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eEmergency laparotomy, primary closure, drainage, and PICU support\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAlive; discharged on POD 24\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e[\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e17\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2024\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eWatanabe et al.\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eJapan\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e15 y\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eM\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNR\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eSevere motor and intellectual disability, impaired peristalsis associated with antiepileptic therapy, malnutrition, and Candida albicans detected\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eEmergency laparotomy, partial gastrectomy, and prolonged antifungal therapy\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAlive; discharged after 2 months\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e[\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e18\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2025\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAssefa et al.\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eEthiopia\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e6 y\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eF\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePrepyloric region\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNo trauma, medication exposure, corrosive ingestion, or H. pylori infection; ischemic change on pathology\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eLaparotomy and Graham omental patch repair\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAlive; discharged on POD 10 and asymptomatic at 3 months\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e[\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e19\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2025\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eDurak et al.\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eTurkey\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2 y\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eF\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNR\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePreviously healthy; presented with abdominal distension, vomiting, and constipation\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eSurgery reported in the abstract; procedural details NR\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNR\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e[\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"11\"\u003eF\u0026thinsp;=\u0026thinsp;female; M\u0026thinsp;=\u0026thinsp;male; NR\u0026thinsp;=\u0026thinsp;not reported; PICU\u0026thinsp;=\u0026thinsp;pediatric intensive care unit; POD\u0026thinsp;=\u0026thinsp;postoperative day; TOF\u0026thinsp;=\u0026thinsp;tetralogy of Fallot.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Spontaneous gastric perforation, pediatric acute abdomen, laparoscopy, children, case report","lastPublishedDoi":"10.21203/rs.3.rs-9399435/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9399435/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003cbr\u003e\nSpontaneous gastric perforation (SGP) is a rare but life-threatening cause of acute abdomen. Although it occurs predominantly in neonates and is occasionally reported in adults, it is only rarely reported in older children, particularly adolescents. Because of its rarity and nonspecific presentation, SGP in this age group is easily misdiagnosed, resulting in delayed treatment. We report a 12-year-old adolescent girl with SGP, representing a rarely reported case in the adolescent age group in both the domestic and international literature, in whom emergency laparoscopic exploration secured an early diagnosis and enabled successful repair. This case, together with a review of the literature, expands the limited clinical experience with SGP in adolescents, highlights the clinical features and rarity of pediatric SGP, and underscores the importance of timely recognition and laparoscopic management in improving outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation\u003c/strong\u003e\u003cbr\u003e\nA 12-year-old adolescent girl presented with a 5-hour history of abdominal pain. She developed sudden severe epigastric pain, assumed an antalgic posture, and had nausea and vomiting. Plain abdominal radiography showed a large amount of free air beneath both hemidiaphragms, suggesting gastrointestinal perforation. Abdominal computed tomography further demonstrated massive intraperitoneal free air, consistent with gastric perforation and diffuse peritonitis. With a presumptive diagnosis of gastric perforation with acute peritonitis, she underwent emergency laparoscopic exploration. Intraoperatively, a round perforation was identified in the prepyloric region of the posterior gastric wall, while the remainder of the stomach appeared normal. The defect was repaired by two-layer primary closure. The patient recovered well after postoperative anti-infective and supportive treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003cbr\u003e\n Although spontaneous gastric perforation has only rarely been reported in older children and adolescents, it should still be considered in the differential diagnosis of pediatric acute abdomen. Prompt imaging evaluation, particularly plain abdominal radiography and computed tomography, is critical for early diagnosis. Timely laparoscopic exploration represents a safe and minimally invasive option for both definitive diagnosis and treatment. This case, together with the literature review, adds to the limited clinical experience with pediatric spontaneous gastric perforation and underscores the importance of early recognition and minimally invasive surgical intervention in improving clinical outcomes.\u003c/p\u003e","manuscriptTitle":"Spontaneous Gastric Perforation in a 12-Year-Old Adolescent Girl: A Case Report and Literature Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-26 15:46:42","doi":"10.21203/rs.3.rs-9399435/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-05T07:48:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-03T20:17:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"18437281705162040918142409252408411211","date":"2026-04-30T12:09:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"146552037456612294138885859371415958484","date":"2026-04-25T13:39:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-22T06:59:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250000598909578872924828610900075846969","date":"2026-04-17T00:38:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-17T00:37:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-16T09:25:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-15T09:29:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-15T09:29:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2026-04-13T06:07:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e750b35d-61ae-4654-93c2-6988fcf1c1cd","owner":[],"postedDate":"April 26th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-05T07:48:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-03T20:17:04+00:00","index":33,"fulltext":""},{"type":"reviewerAgreed","content":"18437281705162040918142409252408411211","date":"2026-04-30T12:09:28+00:00","index":32,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-05T07:55:47+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-26 15:46:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9399435","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9399435","identity":"rs-9399435","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}