Gastrointestinal Bleeding as an Atypical Presentation of Neonatal Gastric Perforation in a Preterm Infant: A Case Report.

Neonatal gastric perforation is a rare but life-threatening surgical emergency that typically occurs during the first week of life. Early diagnosis remains challenging because the initial clinical and radiographic findings may be nonspecific, particularly in preterm infants, yet prompt recognition and surgical intervention are essential for improving outcomes. We report the case of a four-day-old preterm, low birth weight female infant admitted to the neonatal intensive care unit with prematurity and respiratory distress. During hospitalization, she developed hematemesis and melena. Initial abdominal radiography showed no evidence of pneumoperitoneum despite clinical concerns. Repeated clinical evaluation raised suspicion of gastrointestinal perforation, prompting emergency exploratory laparotomy. Intraoperatively, a gastric perforation was identified and surgically repaired. The postoperative course was complicated by a gastric leak, which required further management. The infant subsequently recovered and was discharged in stable condition. This case highlights the importance of maintaining a high index of suspicion for neonatal gastric perforation in preterm and low-birth-weight infants presenting with gastrointestinal bleeding, even in the absence of initial radiographic evidence. Repeated clinical assessment, serial imaging, and timely surgical intervention are crucial for reducing the morbidity and mortality associated with this rare but potentially fatal condition.