Conservative management of isolated gastric pneumatosis in a full-term neonate: a case report

Isolated gastric pneumatosis is an exceptionally rare radiological finding in neonates, with its clinical significance and optimal management in stable, full-term infants remaining poorly defined. A full-term male newborn was delivered at 38 weeks via spontaneous vaginal delivery from an unmonitored pregnancy. Admitted to the NICU for transient respiratory distress, he developed profuse hematemesis on day three. A nasogastric tube was placed, and gastric lavage revealed bright red blood. The infant was hemodynamically stable but anemic (Hb 13.5 g/dL), with isolated epigastric tenderness. Abdominal radiography showed marked gastric distension, and a subsequent CT scan confirmed intramural gastric pneumatosis without pneumoperitoneum or intestinal involvement, ruling out a lactobezoar. He was managed conservatively with strict NPO status, intravenous omeprazole (1 mg/kg twice daily), and intravenous antibiotics (ampicillin and gentamicin). A follow-up abdominal X-ray 48 hours later confirmed complete resolution of the pneumatosis. Enteral feeding with hydrolyzed formula was successfully reintroduced on the third day post-diagnosis. The patient was discharged on the fourth day, tolerating full feeds, and remained asymptomatic at follow-up. Isolated gastric pneumatosis in the absence of pneumoperitoneum may be managed conservatively with proton pump inhibitors, diet restriction and empiric antibiotics. Frequent clinical and radiological surveillance is required for the early detection of potential complications.