Early diagnosis and laparoscopic treatment of congenital gastric wall muscular defect

Objective To summarize the clinical features of congenital gastric wall muscular defect and explore the role of laparoscopy in its early diagnosis and treatment prior to gastric rupture in neonates. Methods Clinical parameters of two neonates with congenital gastric wall muscular defect undergoing laparoscopy in 2018 were analyzed.There were 1 3-day-old full-term boy and 1 4-day-old premature girl with a gestational age of 38+ 2 and 34 weeks and a body weight of 2540 and 1800 grams.Both cases were characterized by abdominal distension and self-defecation.All infection parameters were normal.Abdominal radiology indicated a giant gastric bubble and gastrointestinal decompression was ineffective.Upper gastroenterography showed decreased gastric peristalsis and obstruction of contrast media through pylorus.During laparoscopic exploration, congenital gastric wall muscular defect was confirmed without perforation.Then laparoscopic gastric wall repair was performed. Results There was no obvious sign of postoperative infection or anastomotic leakage.At Week 1 post-operatively, upper gastroenterography showed that both gastric wall shape and peristalsis ability were normal.After gradual feeding, there was no vomiting or other discomforts before discharging.The database searches of CNKI, Wanfang, CQVIP, Pubmed, Clinicalkey and Google Scholar up until December 2018 yielded no report of laparoscopy in early diagnosis and treatment of congenital gastric wall muscular defect prior to gastric rupture. Conclusions For doubtful cases congenital gastric wall muscular defect with imaging evidence of decreased gastric peristalsis, an exploration of laparoscopy is recommended.And laparoscopy lowers the risks of such serious complications as septicemia and infectious shock after gastric rupture. Key words: Laparoscopes; Gastric wall muscular defect, congenital; Infant, newborn