{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T08:44:12Z","timestamp":1792226652224,"version":"4.4.0"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,20]],"date-time":"2023-09-20T00:00:00Z","timestamp":1695168000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>Neonatal gastric perforation (NGP) is a rare, but life-threatening condition that can lead to serious conditions, such as capillary leak syndrome (CLS). Here, we present the case of a preterm male infant with NGP complicated by CLS after stomach repair. The patient was born at 33 2\/7 weeks, weighed 1,770\u2005g, and was diagnosed with respiratory distress syndrome. On the fourth day of life, the patient presented with distention and an unstable cardiovascular system. Routine blood tests revealed a white blood cell count of 2.4\u2009\u00d7\u200910<jats:sup>9<\/jats:sup>\/L. Chest and abdominal radiography revealed a pneumoperitoneum, suggesting a gastrointestinal perforation. The patient was urgently transferred to a tertiary hospital for exploratory laparotomy, where a 2\u2005cm diameter perforation was discovered in the stomach wall and subsequently repaired. Pathological findings indicated the absence of a muscular layer in the stomach wall. The patient unexpectedly developed CLS postoperatively, leading to multiorgan dysfunction and eventual death. The underlying pathological mechanism of NGP-induced CLS may be related to severe chemical peritonitis, sepsis, endothelial glycocalyx dysfunction, enhanced systemic inflammation, and translocation of the gut microbiota, causing endothelial hyperpermeability. Notablely, abdominal surgery itself can be a significant triggering factor for CLS occurrence. Complications of NGP and CLS are extremely dangerous. Investigating the mechanism by which NGP triggers CLS could potentially improve the prognosis. Conservative treatment for pneumoperitoneum secondary to gastric perforation may be a reasonable option, especially when the condition of the patient is unstable.<\/jats:p>","DOI":"10.3389\/fped.2023.1257491","type":"journal-article","created":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T07:15:27Z","timestamp":1695280527000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Case report: Catastrophic event: neonatal gastric perforation and complication of capillary leak syndrome"],"prefix":"10.3389","volume":"11","author":[{"given":"Jie","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongping","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"LinJun","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiting","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiyang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caie","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enfu","family":"Tao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"652139","DOI":"10.3389\/fped.2021.652139","article-title":"Risk factors for mortality in neonatal gastric perforation: a retrospective cohort study","volume":"9","author":"Huang","year":"2021","journal-title":"Front Pediatr"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2668","DOI":"10.1007\/s00268-018-4509-x","article-title":"Neonatal gastric perforation: case series and literature review","volume":"42","author":"Yang","year":"2018","journal-title":"World J Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.kint.2016.11.029","article-title":"Capillary leak syndrome: etiologies, pathophysiology, and management","volume":"92","author":"Siddall","year":"2017","journal-title":"Kidney Int"},{"key":"B4","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1016\/j.jaci.2016.10.042","article-title":"Idiopathic systemic capillary leak syndrome (Clarkson disease)","volume":"140","author":"Druey","year":"2017","journal-title":"J Allergy Clin Immunol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"573901","DOI":"10.3389\/fsurg.2020.573901","article-title":"An overview of gastroduodenal.perforation","volume":"7","author":"Weledji","year":"2020","journal-title":"Front Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1016\/j.bioactmat.2021.11.038","article-title":"An adhesive and resilient hydrogel for the sealing and treatment of gastric perforation","volume":"14","author":"Chen","year":"2022","journal-title":"Bioact Mater"},{"key":"B7","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1016\/j.ijsu.2013.02.021","article-title":"The challenge of intra-abdominal sepsis","volume":"11","author":"Weledji","year":"2013","journal-title":"Int J Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"364","DOI":"10.3390\/ijms24010364","article-title":"The endothelial glycocalyx and neonatal sepsis","volume":"24","author":"Fatmi","year":"2022","journal-title":"Int J Mol Sci"},{"key":"B9","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1164\/rccm.201910-1911TR","article-title":"Endothelial responses in sepsis","volume":"202","author":"Joffre","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1213\/ANE.0000000000002057","article-title":"Structural behavior of the endothelial glycocalyx is associated with pathophysiologic status in septic mice: an integrated approach to analyzing the behavior and function of the glycocalyx using both electron and fluorescence intravital microscopy","volume":"125","author":"Kataoka","year":"2017","journal-title":"Anesth Analg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"H2235","DOI":"10.1152\/ajpheart.00803.2011","article-title":"Shedding of the endothelial glycocalyx in arterioles, capillaries, and venules and its effect on capillary hemodynamics during inflammation","volume":"301","author":"Lipowsky","year":"2011","journal-title":"Am J Physiol Heart Circ Physiol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1038\/s41467-023-37269-3","article-title":"Sepsis-induced multi-organ dysfunction syndrome\u2014a mechanistic approach","volume":"1","author":"Spapen","year":"2017","journal-title":"J Emerg Crit Care Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1286","DOI":"10.1007\/s00134-010-1893-6","article-title":"The endothelium: physiological functions and role in microcirculatory failure during severe sepsis","volume":"36","author":"Ait-Oufella","year":"2010","journal-title":"Intensive Care Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1042\/CS20220777","article-title":"The leaky gut and the gut microbiome in sepsis - targets in research and treatment","volume":"137","author":"Chancharoenthana","year":"2023","journal-title":"Clin Sci"},{"key":"B15","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1016\/s0022-3468(98)90092-6","article-title":"Multisystem organ failure and capillary leak syndrome in severe necrotizing enterocolitis of very low birth weight infants","volume":"33","author":"Sonntag","year":"1998","journal-title":"J Pediatr Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1186\/s13017-021-00387-8","article-title":"WSES\/GAIS\/SIS-E\/WSIS\/AAST global clinical pathways for patients with intra-abdominal infections","volume":"16","author":"Sartelli","year":"2021","journal-title":"World J Emerg Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1007\/s12519-008-0008-8","article-title":"Is pneumoperitoneum an absolute indication for surgery in necrotizing enterocolitis?","volume":"4","author":"Upadhyaya","year":"2008","journal-title":"World J Pediatr"},{"key":"B18","doi-asserted-by":"publisher","first-page":"61","DOI":"10.3389\/fped.2018.00061","article-title":"Pathogenetic and prognostic factors for neonatal gastric perforation: personal experience and systematic review of the literature","volume":"6","author":"Iacusso","year":"2018","journal-title":"Front Pediatr"},{"key":"B19","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1186\/s12887-019-1641-1","article-title":"Successful conservative treatment of intestinal perforation in VLBW and ELBW neonates: a single centre case series and review of the literature","volume":"19","author":"Ye","year":"2019","journal-title":"BMC Pediatr"},{"key":"B20","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1007\/s003830100671","article-title":"Spontaneous gastroduodenal disruption in neonate","volume":"18","author":"Kothari","year":"2002","journal-title":"Pediatr Surg Int"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1257491\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T07:15:29Z","timestamp":1695280529000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1257491\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,20]]},"references-count":20,"alternative-id":["10.3389\/fped.2023.1257491"],"URL":"https:\/\/doi.org\/10.3389\/fped.2023.1257491","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,20]]},"article-number":"1257491"}}