Rupture of the stomach in the newborn due to congenital defects in the gastric musculature.

A male infant weighing 5 lb. 7 oz. (2-49 kg.) was delivered spontaneously after a normal labour. He was the mother's second child; the pregnancy was uneventful and labour began at term. At birth the infant was pale and respirations were laboured. A few hours after delivery he vomited about 2 ml. of altered blood and was therefore given 10 mg. of vitamin K intramuscularly. With warmth and the administration of oxygen there was an improvement in his condition, which was maintained the next day though he remained limp and reluctant to feed. Forty-eight hours after delivery the infant was still not feeding well, and I oz. of expressed breast milk was given through an intragastric rubber tube. A similar feed was given three hours later. Following it, he vomited and the abdomen was noted to be a little distended. The vomitus consisted largely of milk, but there were a few streaks of fresh blood in it. Three hours later a further tube feed was given, and shortly after this the baby collapsed. He was pale and the abdomen was grossly distended and tympanitic. The scrotum was large and translucent. With pressure it emptied of gas with a gurgling sound, and filled again when released. Crepitant subcutaneous emphysema was felt in the lower abdominal wall extending from the pubis to the umbilicus, mainly on the left side. Plain radiographs were taken FIGS 1 and 2.-Radiogra in the erect and inverted pr positions (Figs. 1, 2, 3, 4). These showed a gross pneumoperitoneum with gas in the scrotum and in the subcutaneous tissues of the lower abdominal wall. There was some free fluid in the peritoneal cavity and gas was clearly seen in the lower sigmoid colon and rectum. The clinical and radiological evidence of such a large pneumoperitoneum without an intestinal obstruction suggested a high perforation, probably of the stomach. At laparotomy (Mr. J. J. Mason Brown) gas under considerable tension escaped and the peritoneal cavity was seen to contain bile-stained fluid with a few flakes of milk. A rupture of the stomach was found which extended over the anterior wall from the greater curvature to the lower oesophagus. The upper half involved all coats of the gastric wall, but in the lower half the mucosa was intact. This rupture was closed with silk sutures without great difficulty, though it was noted that the gastric wall was thin and the sutures were liable to cut out. After the operation the infant's condition was