Spontaneous gastric rupture in a pre-school child preceded by generalised fits and presenting with tension hydropneumoperitoneum

Spontaneous perforation of a normal stomach is a rare event especially in the paediatric non-neonatal age group and mainly reported in the Chinese and Japanese literature. We report the first case in the Asia Pacific preceded by a generalised fit. A previously healthy 2 year old Malay boy presented with convulsions and vomiting. Post-ictally, his abdomen was distended. He was intubated for airway protection. Transfer to a paediatric surgical centre was delayed by about 12 hours because the diagnosis was disputed and by then patient became unstable with a tension hydropneumoperitoneum resulting in cardiovascular collapse. This was relieved by an abdominal needle paracentesis and he was stable for transfer. The findings of the laparotomy was a simple perforation at the lesser curvature of the stomach. The child survived following intensive postoperative care with neurological impairment. Histopathological report did not show any abnormality. Hence we postulate that epilepsy could cause gastric distension leading to perforation. In conclusion, gastric rupture can follow an epileptic fit and patients deteriorate rapidly hence early diagnosis is vital.