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An 3‐day‐old baby, who was being treated for probable sepsis, developed acute abdominal distension. On examination he was pale, and had tachycardia and tachypnoea and cold, dusky extremities. He responded only to pain. The abdomen was distended, tense and tender with absent bowel sounds. The scrotum was distended, translucent and non‐erythematous. He had been on nasogastric tube feeds (NGT), with concomitant oxygen administration via a feeding tube inserted at 5 cm into the left nostril. It transpired that a few minutes earlier, the oxygen tube had got disconnected and has been inadvertently connected to the NGT. This error was detected because of the dramatic, translucent scrotal swelling. A laparotomy after initial stabilisation revealed a 1.5×0.5 cm perforation in the greater curvature, which was successfully sealed.
Spontaneous gastric perforation in a newborn is rare, but has been reported.1 It is different from the ileal perforations seen in necrotising enterocolitis. Gastric perforation has been reported previously in association with nasogastric feeding.2 Oxygen is commonly administered through a nasal catheter in resource‐poor settings, because it is effective, inexpensive and achievable at low oxygen flow.3 However, it is a potential source of error because these infants are also often receiving nasogastric feeds, and the tubes are indistinguishable. Such errors can perhaps be minimised by labelling the tubes and ensuring that oxygen flow is kept below 2 l/min if low‐range flow meters are not available. In our case, the perforation of the stomach wall caused marked distension of the scrotum in just a few minutes, via the patent processus vaginalis. An acute scrotal swelling in a neonate, as described here, should prompt suspicion of gastric perforation.
Competing interests: None.