Spontaneous gastric perforation in a 12-year-old adolescent girl: a case report and literature review

Spontaneous gastric perforation (SGP) is a rare but life-threatening acute abdominal emergency. It is more commonly reported in neonates, whereas cases in older children and adolescents are uncommon. Because of its nonspecific clinical manifestations, SGP is prone to misdiagnosis or delayed treatment. We report a successfully treated case of SGP in a 12-year-old girl, with the perforation located in the relatively concealed posterior prepyloric region of the stomach. Combined with a literature review, this report discusses the clinical features, potential pathogenesis, imaging findings, and diagnostic and therapeutic strategies of pediatric SGP, and evaluates the clinical value of laparoscopic exploration in early diagnosis and treatment. A 12-year-old adolescent girl was admitted with a 5-h history of abdominal pain. She presented with sudden severe epigastric pain, a forced posture, nausea, and vomiting. Abdominal radiography showed a large amount of free gas beneath both hemidiaphragms, suggesting gastrointestinal perforation. Abdominal computed tomography further supported the preliminary diagnosis of gastric perforation with acute peritonitis. Emergency laparoscopic exploration revealed an approximately 0.5 cm × 0.5 cm round perforation in the posterior prepyloric wall of the stomach, with no obvious abnormalities in the remaining gastric wall. Laparoscopic two-layer primary suture repair was performed. Postoperatively, the patient received anti-infective and supportive treatment, recovered well, and experienced no related complications during follow-up. Although SGP is rare in older children and adolescents, it should be included in the differential diagnosis of pediatric acute abdomen. Perforation of the posterior prepyloric wall is relatively concealed, and early clinical manifestations and inflammatory responses may be atypical, increasing the risk of missed diagnosis. Timely imaging evaluation is essential for early diagnosis. In children with a short disease course, stable vital signs, limited intra-abdominal contamination, and a small perforation, laparoscopic exploration can help identify the perforation site and assess the degree of contamination, while allowing simultaneous minimally invasive repair. This case suggests that early recognition, prompt imaging assessment, and individualized surgical decision-making are key to improving clinical outcomes in pediatric SGP.