Nasogastric Tube-Induced Gastric Perforation as a Rare Cause of Pneumoperitoneum in Premature Neonates: A Case Series Highlighting Individualized Approaches

Abstract

Nasogastric tube (NGT)-induced gastric perforation is an uncommon but serious complication in premature neonates, often presenting as pneumoperitoneum. This case series presents two preterm infants with similar initial presentations but contrasting management strategies and clinical outcomes. The first case involved a 30-week gestation neonate who developed abdominal distension while remaining hemodynamically stable. Radiography confirmed pneumoperitoneum, and conservative management was pursued with bedside glove drain insertion. The NGT was found to have perforated the greater curvature of the stomach in the X ray. After drainage, antibiotic therapy, and supportive care, the neonate recovered fully without requiring surgical intervention. The second case involved a 29-week neonate on presenting with progressive abdominal distension. Radiographic findings suggested pneumoperitoneum which persisted and progressed even after the bedside glove drain insertion, hence taken up for an emergency laparotomy, which revealed a full-thickness gastric perforation at the fundus caused by the NGT. Surgical repair was performed, and the patient recovered following antibiotic therapy and parenteral nutrition. These cases underscore the importance of individualized treatment strategies in NGT-related gastric perforation. Conservative management may be successful in stable neonates with limited contamination, while surgery remains necessary in cases with clinical deterioration or suspected sepsis. Early recognition, appropriate imaging, and careful NGT placement are essential for prevention and management. This series contributes to the limited literature guiding treatment in this rare neonatal emergency