Case report of successful conservative management of neonatal gastrointestinal perforation and intestinal stenosis

RATIONALE: Neonatal gastrointestinal perforation (NGP) is a life-threatening condition requiring urgent intervention. While exploratory laparotomy remains the standard treatment, conservative management offers an alternative when surgery is not feasible. This case demonstrates the successful use of comprehensive conservative therapy in a high-risk infant with NGP and suspected intestinal stenosis. PATIENT CONCERNS: A 6-day-old, small-for-gestational-age male infant presented with vomiting, abdominal distension, and respiratory distress. Clinical deterioration led to the diagnosis of pneumoperitoneum, sepsis, and suspected necrotizing enterocolitis. DIAGNOSES: NGP secondary to suspected necrotizing enterocolitis, with complications including septic shock, purulent meningitis, scrotal abscess, zinc deficiency, and malnutrition. INTERVENTIONS: Following parental refusal of laparotomy, conservative management was initiated, including peritoneal drainage, gastrointestinal decompression, broad-spectrum antibiotics, inotropic support, and parenteral nutrition. Nutritional support included zinc supplementation and gradual enteral feeding. OUTCOMES: The infant survived after 134 days of hospitalization, despite multiple complications. Long-term follow-up at 8 months revealed neurodevelopmental delays (developmental quotient 61), though physical growth was adequate with successful transition to complementary feeding. LESSONS: This case confirms that conservative management with peritoneal drainage and intensive multidisciplinary support can be a viable option for NGP, even in complex scenarios where surgery is not possible. It underscores the importance of vigilant monitoring, nutritional management, and awareness of potential long-term neurodevelopmental sequelae in such cases.