PC1197: Father's Kiss Causing a Gastric Perforation: Case Report

Introduction: Gastric perforation is a rare, but potentially fatal condition in the pediatric population often associated with trauma, ulcers, or malignancy. A “Mother’s Kiss”(MK) is a technique to remove nasal foreign bodies where a caregiver forcefully blows into the child’s mouth against a closed glottis in an attempt to dislodge the foreign body. To date, there is no literature published on a MK causing gastric perforation. We present a case of a 4-year-old with a gastric perforation of the lesser curvature of the stomach after receiving a MK from her father.

Case Description: A 4-year-old otherwise healthy female presented to the emergency department (ED) with acute onset abdominal pain, distention, vomiting, and dyspnea. It was reported that symptoms began after the father placed his mouth over the child’s mouth and blew air forcefully into her mouth in order to clear nasal congestion, which he had done several times that day. In the ED, an abdominal radiograph (XR) was significant for massive pneumoperitoneum. She was transferred to our pediatric ED where intravenous fluids (IVF), supplemental oxygen (O2), broad spectrum antibiotics, and nasogastric tube (NGT) placement were initiated. A repeat abdominal XR confirmed massive pneumoperitoneum. She was transferred to the operating room (OR) where an exploratory laparotomy was performed revealing a 2.5cm perforation in the lesser curvature of the stomach, inferior to the gastroesophageal junction and repaired with primary closure. At the time of this report, she remains hospitalized and recovering uneventfully.

Discussion: Gastric perforation in the pediatric patient is rare, but often fatal with trauma being the most common cause. The most common site of perforation is along the greater curvature of the stomach. When a child presents with severe acute abdominal pain and distention, hollow viscus perforation should be considered as a differential diagnosis especially in the presence of known or suspected trauma or a significant past medical or surgical history. Management includes stabilization of the airway, breathing, and circulation (ABCs), followed by administration of IVF and evaluation with radiographic imaging with XR considered as first line. Once pneumoperitoneum is confirmed, patients should be made nothing by mouth (NPO), an NGT should be placed for gastric decompression, and broad-spectrum antibiotics initiated. Patients require immediate surgical consultation or transfer to a dedicated pediatric trauma center for surgical evaluation. Late presentations are associated with sepsis, prolonged recovery and death.

Conclusion: Gastric perforation is exceedingly rare in the pediatric patient. There are no previous reports of perforation occurring from barotrauma after administration of a “Mother’s Kiss”. Given the constellation of findings of acute onset abdominal pain and distention in a child, a high index of suspicion is required, with focus on stabilization, rapid diagnosis with imaging, administration of broad spectrum antibiotics, and definitive surgical management.