Spontaneous gastric perforation is an important but rare cause of gastrointestinal perforation in neonates. Just over 200 cases have been reported in the literatures. In spite of recent surgical advances in its managements, mortality rate has been reported as high as 25~50%. Because of physiologic differences, immature immune mechanisms, variations in gastrointestinal flora and poor localization of perforation, a neonate with gastric perforation is at high risk. The pathogenesis is greatly debated. Five patients with spontaneous neonatal gastric perforation who were operated upon at the Department of Pediatric Surgery, Seoul National University Hospital from 1980 to 1993 were reviewed. Four patients were male and one female. The first indication of perforation was 1 day to 6 days of life. All of 5 perforations were located along the greater curvature of the stomach. The size of perforation ranged from 2 cm to 10 cm. Debridement and primary closure were performed in all patients. The operative mortality was 40%(2 of 5). The cause of perforation was not identified in all cases. Prematurity and necrotizing enterocolitis, synchronous or metachrotlous, were thought to be crucial prognostic factors. Earlier recognition and surgical intervention are necessary to reduce morbidity and mortality.

Aberrant migration of thymic tissue occurs as an ectopic thymus in the mediastinum, base of skull, tracheal bifurcation, and cervical region. A recent review of the literature by Nowak et al. showed over 70 reported cases of aberrant thymus or thymic cyst in patients who presented with primary neck masses. Authors experienced a case of ectopic cervical thymus and reviewed the literature. A one-year-old boy with left neck swelling which had been noticed since one month of age visited out patient clinic. Ultrasonography showed a well-defined cystic mass containing homogeneous, low-echogenic content locating in the lateral aspect of the left carotid sheath. Operation was performed under the impression of branchial cleft cyst. At surgery, a multiseptated, well-encapsulated, brownish and doughy mass which was extending into the vicinity of the carotid bifurcation with sland stalk-like portion ending between the hypoglossal nerve and external carotid artery was excised completely. The cut-surface showed homogenous solid mass, and on frozen section the tissue revealed a normal thymic histology. Postoperative ultrasonography showed bilateral thymus in the superior mediastinum. The patient has no immunologic problem and is doing well now.