Pneumo-omentocele - a Sign of Silent Lethal Neonatal Posterior Gastric Perforation

A case of silent lethal posterior neonatal gastric perforation in a term neonate who had severe respiratory distress syndrome following meconium aspiration and difficult intubation at birth has been reported. He underwent very successful and costly treatment of meconium aspiration with extracorporeal membrane oxygenation (ECMO) but succumbed to unrecognized silent posterior gastric perforation although clinically he deteriorated progressively following oral feeding, inflammatory markers started climbing and the radiological findings of lobulated collection of air in the two layers of greater omentum of the lesser sac boundary well outside the bowel outline were not timely co-ordinated leading to septicaemia, multiple organ failure and death.