Gastric perforation in the neonatal period is rare; however, it continues to be associated with significant morbidity and mortality. Spontaneous neonatal gastric perforation is estimated to occur in 1 in 2900 live births1 and accounts for approximately 10%–15% of all gastrointestinal perforations in neonates and children. Gastrointestinal perforations occur more commonly in males; however, there appears to be no sex predilection for those occurring in the stomach.2 Recent series may suggest a male predominance, but this remains inconclusive.3 The incidence of gastrointestinal perforation is increasing in some populations; however, the relative incidence of gastric perforation is decreasing.4 The terminology used to describe neonatal gastric perforation has been inconsistent, and its etiology remains a topic of debate. Spontaneous or idiopathic gastric perforations refer to those with no identifiable underlying cause and account for the majority of gastric perforations in most reported series.1 , 5 Nevertheless, many pediatric surgeons believe that an underlying cause can be found in most cases of neonatal gastric perforation.6