Neonatal gastric necrosis and perforation associated with impacted medication

Abstract

Introduction: Gastric perforation is a serious life-threatening condition in newborns. Its etiologies include idiopathy, distal obstruction, high acidity with local ischemia, and iatrogenesis. Moreover, there have been some reports of Kalimate (a potassium-lowering agent) possibly being irritated, obstructed, and necrotized the gastric mucosa. This article reports on the risk of gastric necrosis and perforation while using this potassium-lowering agent, as well as management of this complication. Methodology: Case report. Patient information: A female infant was born at 38 weeks gestation, weighting 3180 g. She had undergone a central shunt on the 13th day of life due to complex heart disease. The first day after the operation, the infant was found to have an acute kidney injury and hyperkalemia. After successful resuscitation from cardiac arrest, she was administered intravenous calcium gluconate, sodium bicarbonate, and oral calcium polystyrene sulfonate (Kalimate®). The infant's abdomen became distended and abdominal radiography showed pneumoperitoneum and an opaque particle at the upper-left quadrant of the abdomen. The patient was then referred to our hospital, where an exploratory laparotomy was immediately performed. We found a large area of necrosis and a rupture along the greater curvature of the stomach that extended to the fundus with impaction of the medical bezoars inside and generalized contamination of the abdominal cavity. After the operation, the infant clinically improved. Conclusion: These findings suggest that physicians should be aware of potentially serious complications while using this potassium-lowering agent and point to the importance of early surgical intervention in cases of neonatal gastric perforation. Keywords: Stomach, Perforation, Necrosis, Neonate, Kalimate