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Pijpers AGH, Gorter RR, Eeftinck Schattenkerk LD, van Schuppen J, van den Akker CHP, Vanhamel S, van Heurn ELW, Musters GD, Derikx JPM. Identifying Preoperative Clinical Characteristics of Unexpected Gastrointestinal Perforation in Infants-A Retrospective Cohort Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:505. [PMID: 38790500 PMCID: PMC11119732 DOI: 10.3390/children11050505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/08/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Infants presenting with unexpected pneumoperitoneum upon abdominal X-ray, indicating a gastrointestinal perforation (GIP), have a surgical emergency with potential morbidity and mortality. Preoperative determination of the location of perforation is challenging but will aid the surgeon in optimizing the surgical strategy, as colon perforations are more challenging than small bowel perforations. Therefore, the aim of this study is to provide an overview of preoperative patient characteristics, determine the differences between the small bowel and colon, and determine underlying causes in a cohort of infants with unexpected GIP. METHODS All infants (age ≤ 6 months) who presented at our center with unexpected pneumoperitoneum (no signs of pneumatosis before) undergoing surgery between 1996 and 2024 were retrospectively included. The differences between the location of perforation were analyzed using chi-squared and t-tests. Bonferroni correction was used to adjust for multiple tests. RESULTS In total, 51 infants presented with unexpected pneumoperitoneum at our center, predominantly male (N = 36/51) and premature (N = 40/51). Among them, twenty-six had small bowel, twenty-two colon, and three stomach perforations. Prematurity (p = 0.001), birthweight < 1000 g (p = 0.001), respiratory support (p = 0.001), and lower median arterial pH levels (p = 0.001) were more present in patients with small bowel perforation compared with colon perforations. Pneumatosis intestinalis was more present in patients with colon perforation (p = 0.004). All patients with Hirschsprung disease and cystic fibrosis had colon perforation. The final diagnoses were mainly focal intestinal perforations (N = 27/51) and necrotizing enterocolitis (N = 9/51). CONCLUSIONS Infants with unexpected GIP, birthweight < 1000 g, and prematurity have more risk for small bowel perforation. In case of colon perforation, additional screening (for Hirschsprung and cystic fibrosis) should be considered.
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Affiliation(s)
- Adinda G. H. Pijpers
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, 1105 AZ Amsterdam, The Netherlands
| | - Ramon R. Gorter
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Laurens D. Eeftinck Schattenkerk
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Joost van Schuppen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Chris H. P. van den Akker
- Amsterdam Reproduction & Development Research Institute, 1105 AZ Amsterdam, The Netherlands
- Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Sylvie Vanhamel
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Ernest L. W. van Heurn
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Gijsbert D. Musters
- Department of Surgery, Zaans Medisch Centrum, Koningin Julianaplein 58, 1502 DV Zaandam, The Netherlands
| | - Joep P. M. Derikx
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Boughaba N. Spontaneous Newborn Idiopathic Gastric Perforation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Nagaraja S, Leichsenring K, Ambati M, De Lorenzis L, Böl M. On a phase-field approach to model fracture of small intestine walls. Acta Biomater 2021; 130:317-331. [PMID: 34119714 DOI: 10.1016/j.actbio.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 12/15/2022]
Abstract
We address anisotropic elasticity and fracture in small intestine walls (SIWs) with both experimental and computational methods. Uniaxial tension experiments are performed on porcine SIW samples with varying alignments and quantify their nonlinear elastic anisotropic behavior. Fracture experiments on notched SIW strips reveal a high sensitivity of the crack propagation direction and the failure stress on the tissue orientation. From a modeling point of view, the observed anisotropic elastic response is studied with a continuum mechanical model stemming from a strain energy density with a neo-Hookean component and an anisotropic component with four families of fibers. Fracture is addressed with the phase-field approach, featuring two-fold anisotropy in the fracture toughness. Elastic and fracture model parameters are calibrated based on the experimental data, using the maximum and minimum limits of the experimental stress-stretch data set. A very good agreement between experimental data and computational results is obtained, the role of anisotropy being effectively captured by the proposed model in both the elastic and the fracture behavior. STATEMENT OF SIGNIFICANCE: This article reports a comprehensive experimental data set on the mechanical failure behavior of small intestinal tissue, and presents the corresponding protocols for preparing and testing the samples. On the one hand, the results of this study contribute to the understanding of small intestine mechanics and thus to understanding of load transfer mechanisms inside the tissue. On the other hand, these results are used as input for a phase-field modelling approach, presented in this article. The presented model can reproduce the mechanical failure behavior of the small intestine in an excellent way and is thus a promising tool for the future mechanical description of diseased small intestinal tissue.
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Sakaria RP, Zaveri PG. Neonatal Gastric Perforation: 14-Year Experience from a Tertiary Neonatal Intensive Care Unit. Am J Perinatol 2021. [PMID: 34327684 DOI: 10.1055/s-0041-1733780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Neonatal gastric perforations (NGPs) are rare and account for 7 to 12% of all gastrointestinal perforations in the neonatal period. The etiology and prognostic factors associated with NGP remain unclear. The aim of this study is to review the cases of NGP in our neonatal intensive care unit (NICU) in the past 14 years and describe the risk factors, clinical presentation, and outcomes associated with it. STUDY DESIGN A retrospective chart review of neonates with gastric perforation admitted to the NICU between June 2006 and December 2020 was performed. Data regarding their antenatal and neonatal characteristics, laboratory and radiological results, intra-operative findings, hospital course, and outcomes were recorded. RESULTS We identified 350 patients with gastrointestinal perforation at our center during the study period of which 14 (4%; nine males and five females) patients were diagnosed with NGP during surgery. A total of 71% neonates were born preterm (range: 24-39 weeks, median: 34 weeks). Two neonates (14%) were SGA. Only one neonate received cardiopulmonary resuscitation at birth. In all neonates, except two, perforation occurred within the first 10 days of life (median: 4 days, range: 1-22 days). In total, 79% infants received feeds prior to perforation. Ten neonates had a feeding tube, and one neonate had a gastrostomy tube placed prior to perforation. Abdominal distension and pneumoperitoneum were present in all neonates. Majority of the babies had metabolic acidosis (64%) and elevated C-reactive protein (79%). Most (86%) neonates received surgical intervention within 12 hours. Overall survival in our study was 93%. CONCLUSION NGP is a rare entity seen mostly in preterm infants within the first 10 days of life. Clinical presentation is similar to perforation anywhere along the gastrointestinal tract and definite diagnosis requires exploratory laparotomy. With prompt recognition and surgical intervention, the overall mortality related to neonatal gastric perforation is low. KEY POINTS · Neonatal gastric perforation is a rare but life threatening entity with unclear etiology.. · Prematurity is associated with an increased incidence of gastric perforations in the neonate.. · Laparotomy is required for definitive diagnosis and treatment..
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Affiliation(s)
- Rishika P Sakaria
- Division of Neonatology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Parul G Zaveri
- Division of Neonatology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
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Hashim I, Talat N, Iqbal A, Choudhary MS, Haider N, Nayyer SI, Sharif M, Wasti AR, Ahmad S. Spontaneous gastric perforation: is it really common? ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00083-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Neonatal gastric perforation (NGP) is a rare, serious, and life-threatening condition which needs early recognition with prompt intervention for better prognosis. Its etiology is not yet well established, but multiple speculations have been put forth for its etiopathogenesis. Few most considered are traumatic, spontaneous, or secondary to inflammatory process like necrotizing enterocolitis. This study describes the etiological and prognostic factors for patients with NGP in our experience at a single center.
Results
A total of 46 neonates were included. Male gender predominated with M:F being 1.7:1. Most (n=36) neonates presented within 10 days of life whereas 8 neonates presented within 15 days. At presentation, gas under diaphragm was the most common radiologic finding in 25 (54.3%) neonates. On exploratory laparotomy, it was found that greater curvature was involved in maximum number of cases (n=27), followed by lesser curvature and anterior and posterior walls of the stomach. Most of perforations were within 1–5 cm in size. Gastrorrhaphy was done in all cases, and in two cases, feeding jejunostomy was done along with repair for feeding purpose. Finally, spontaneous NGP was diagnosed in 30 (60.8%), and NEC patches on other parts of the intestine were seen in 11 patients. Postoperatively, 28 neonates developed complications in the form of sepsis (n=13), wound infection (n=10), and burst abdomen (n=5). Regarding clinical outcome, 27 (58.7%) were discharged from the hospital whereas 19 (39.3%) patients died.
Conclusion
Our results show that spontaneous NGP is most commonly associated with NEC in our population, usually affecting the greater curvature. We observed a high mortality rate; however, good ICU care may improve the survival.
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Huang Y, Wu Y, Jin D, Tang Q, Yuan P, Lu Q. Development and Validation of a Nomogram for Preoperative Prediction of Localization of Neonatal Gastrointestinal Perforation. Front Pediatr 2021; 9:754623. [PMID: 34796155 PMCID: PMC8593177 DOI: 10.3389/fped.2021.754623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/06/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Information regarding the localization of gastrointestinal perforation is crucial for the following surgical procedure. This study was to determine the key indicators and develop a prediction model for the localization in neonates with gastrointestinal perforation. Methods: A nomogram to predict the location of neonatal gastrointestinal perforation was developed using a cohort of patients who underwent surgery between July 2009 and May 2021. Baseline variables were analyzed using logistics regression and nomogram developed using significant predictors. The predictive performance of the nomogram was assessed by the concordance index (C-index), calibration curve, and area under the receiver operating characteristic (ROC) curve (AUC). The nomogram was further validated in an integrated external cohort. Results: We investigated the data of 201 patients, of which 65 (32.3%) were confirmed with upper gastrointestinal perforation by surgery. Multivariate logistic regression analysis identified the following as independent predictors: preterm [OR: 5.014 (1.492-18.922)], time of onset [OR: 0.705 (0.582-0.829)], preoperative hemoglobin [OR:1.017 (1.001-1.033)], bloody stool: No [OR: 4.860 (1.270-23.588)], shock [OR: 5.790 (1.683-22.455)] and sepsis: No [OR 3.044 (1.124-8.581)]. Furthermore, the nomogram was effective in predicting the perforation site, with an AUC of 0.876 [95% confidence interval (CI): 0.830-0.923]. Internal validation showed that the average AUC was 0.861. Additionally, the model achieved satisfactory discrimination (AUC, 0.900; 95% CI, 0.826-0.974) and calibration (Hosmer-Lemeshow test, P = 0.4802) in external validation. Conclusions: The nomogram based on the six factors revealed good discrimination and calibration, suggesting good clinical utility. The nomogram could help surgeons predict the location of gastrointestinal perforation before surgery to make a surgical plan.
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Affiliation(s)
- Yao Huang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yuhua Wu
- Department of Neonatology, The General Hospital of Ningxia Medical University, Ningxia, China
| | - Dongmei Jin
- Department of Neonatology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qing Tang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Peng Yuan
- Department of Neonatal Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Lu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Abo-Halawa NAE, Negm MA, Fathy M. The pattern of neonatal gastro-intestinal perforation in upper Egypt. ANNALS OF PEDIATRIC SURGERY 2020; 16:17. [PMID: 34899877 PMCID: PMC7314571 DOI: 10.1186/s43159-020-00029-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 05/15/2020] [Indexed: 11/26/2022] Open
Abstract
Background Neonatal gastro-intestinal perforation [NGIP] is one of the major problems in pediatric surgical practice. Although the outcomes of neonatal surgery have improved markedly over the past decade the mortality rates of neonates with NGIP are still high. The aim of this study was to present the possible etiological factors, clinical findings, and operative procedures of NIP in our locality. Results A total of 34 neonates with NGIP were included in this study. The median age at presentation was (15.8 ± 7.0 SD) days. The median interval between presentation and surgical interference was (2.0 ± 1.1 SD).Necrotizing enterocolitis [NEC] was the commonest cause of neonatal gastro-intestinal perforation. The commonest site of perforation was the colon [11cases]. The overall mortality rate was 11 cases [32.4%]. The main cause of mortality was neonatal NEC [6 cases]. Eight cases [40 %] died out of 20 cases which the interval between the presentation and interference were more than one day. Conclusions Neonatal gastro-intestinal perforations are still associated with high mortality rate in our institutions, and delayed diagnosis with increased interval between the presentation and surgical intervention are associated with increased mortality. In our locality, although NEC is the commonest cause of NGIP, the iatrogenic cause is relatively higher than reported.
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Affiliation(s)
| | - Mohamed Ahmed Negm
- Pediatric Surgery unit, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Mohamed Fathy
- Pediatric Surgery Unit, Faculty of Medicine, Minia University, Minia, Egypt
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Sadat AS, Thotan SP, Prabhu SP, Kumar V, Ranjini R. Large Sealed Neonatal Gastric Perforation: A Case Report. Clin Pediatr (Phila) 2019; 58:1321-1323. [PMID: 31452401 DOI: 10.1177/0009922819870556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - Vijay Kumar
- Manipal Academy of Higher Education, Manipal, India
| | - R Ranjini
- Manipal Academy of Higher Education, Manipal, India
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Thaiwatcharamas K, Phannua R, Chusilp S, Tanming P, Areemit S. Neonatal gastric necrosis and perforation associated with impacted medication. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2018.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Babayigit A, Ozaydın S, Cetinkaya M, Sander S. Neonatal gastric perforations in very low birth weight infants: a single center experience and review of the literature. Pediatr Surg Int 2018; 34:79-84. [PMID: 29079904 DOI: 10.1007/s00383-017-4205-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Gastric perforation is a rare condition with high mortality rates in preterm infants. The aim of this retrospective study was to define the risk factors and prognosis in very low birth weight (VLBW) infants with gastric perforations. METHODS VLBW infants with a diagnosis of gastric perforation between 2012 and 2016 were included. The data including birth weight, gestational age, gender, risk factors, time and location of the perforation and prognosis were recorded. RESULTS A total of eight infants were identified. The median gestational age and birth weight of the infants were 26 weeks and 860 g, respectively. Five were male and 6 (75%) had a diagnosis of hemodynamically significant patent ductus arteriosus (PDA), early sepsis, persistent hypotension, and drug administration (paracetamol, ibuprofen). The main clinical finding was abdominal distension and pneumoperitoneum was detected in all infants. The median diagnosis was 6 days of life. The median perforation size was 2.5 cm and curvature major and anterior wall were the most common locations. The mortality rate was 62.5%. CONCLUSION Male gender, chorioamnionitis, early sepsis, asphyxia, hemodynamic PDA, persistent hypotension, ibuprofen and paracetamol usage, and orogastric catheter administration were the main risk factors for gastric perforations in VLBW infants.
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Affiliation(s)
- Aslan Babayigit
- Department of Neonatology, Kanuni Sultan Suleyman Training and Research Hospital, Turgut Ozal Caddesi No:1 34303 Altınsehir, Kucukcekmece, Istanbul, Turkey
| | - Seyithan Ozaydın
- Department of Neonatology, Kanuni Sultan Suleyman Training and Research Hospital, Turgut Ozal Caddesi No:1 34303 Altınsehir, Kucukcekmece, Istanbul, Turkey.,Department of Pediatric Surgery, Kanuni Sultan Suleyman Training and Research Hospital, Turgut Ozal Caddesi No:1 34303 Altınsehir, Kucukcekmece, Istanbul, Turkey
| | - Merih Cetinkaya
- Department of Neonatology, Kanuni Sultan Suleyman Training and Research Hospital, Turgut Ozal Caddesi No:1 34303 Altınsehir, Kucukcekmece, Istanbul, Turkey.
| | - Serdar Sander
- Department of Neonatology, Kanuni Sultan Suleyman Training and Research Hospital, Turgut Ozal Caddesi No:1 34303 Altınsehir, Kucukcekmece, Istanbul, Turkey.,Department of Pediatric Surgery, Kanuni Sultan Suleyman Training and Research Hospital, Turgut Ozal Caddesi No:1 34303 Altınsehir, Kucukcekmece, Istanbul, Turkey
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Congenital Mesenteric Defect: A Rare Cause of Intestinal Perforation. Indian J Pediatr 2017; 84:158-159. [PMID: 27595576 DOI: 10.1007/s12098-016-2222-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 08/17/2016] [Indexed: 10/21/2022]
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Neonatal Gastrointestinal Perforations: the 10-Year Experience of a Reference Hospital. Indian J Surg 2016; 79:431-436. [PMID: 29089704 DOI: 10.1007/s12262-016-1565-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/20/2016] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to present our experiences with, as well as the factors that affect, the treatment and outcome of patients with neonatal gastrointestinal perforations (GIPs). Thirty-eight newborn cases that were operated on for GIP in our hospital's tertiary newborn intensive care unit between January 2005 and December 2015 were retrospectively evaluated. The patients were divided into the two following groups: group 1, perforations related to necrotizing enterocolitis (NEC), and group 2, non-NEC perforations. In total, 38 patients (16 males, 22 females) participated in this study. The perforations were related to NEC in 12 patients (group 1; 31.6 %), and the other 26 patients (group 2; 68.4 %) were classified as non-NEC perforation cases. The incidence of neonatal GIP was 0.53 % in all newborn patients, while the incidence of perforation in NEC cases was 20 %. Of all patients, 25 (65.7 %) were premature. Non-NEC pathologies were the most common cause of GIP (68.4 %) and included stomach perforation related to a nasogastric catheter (n = 5), volvulus (n = 4), intestinal atresia (n = 3), esophageal atresia and tracheoesophageal fistula (n = 2), cystic fibrosis (n = 2), Hirschprung's disease (n = 2), appendicitis (n = 2), congenital stomach anterior wall weakness (n = 1), duplication cyst (n = 1), invagination (n = 1), incarcerated inguinal hernia (n = 1), and idiopathic causes (n = 2). Primary surgical repair was performed in all cases without a conservative approach. The mortality rate related to GIP in newborn cases was 47.3 %. While the mortality rate in group 1 was 66.6 %, it was statistically insignificantly lower in group 2 (38.4 %) (p > 0.05). In group 1, the mortality rate of those with intestinal and colorectal perforations was 45.6 and 20 %, respectively (p > 0.05). Non-NEC pathologies are the most frequent causes of GIP in newborns, and primary surgical repair is the primary treatment choice for neonatal GIP. However, GIP remains one of the most significant causes of mortality in newborns. While the prognosis for neonatal colon perforation is good, that for stomach and jejunoileal perforations is worse.
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Seltene Ursache eines akuten Abdomens beim Frühgeborenen. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-015-0017-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chen CJ, Chuang JP. Conservative Surgery for Right Colon Perforation Leads to Better Long-Term Outcomes in Children: A 21-year Experience. Pediatr Neonatol 2015; 56:159-64. [PMID: 25446523 DOI: 10.1016/j.pedneo.2014.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 08/14/2014] [Accepted: 09/07/2014] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE There is no consensus on standard treatment for right colon perforation in pediatric patients. We reviewed our cases over the past 21 years, comparing the effects of different operations to the long-term growth of patients. METHODS From February 1990 to October 2011, 29 patients of right colon perforation were enrolled in our analysis after excluding tumors, diverticulum, volvulus, and tuberculosis. Clinical information was collected from medical records, and analysis was done over 26 cases younger than 10 years at the time of the treatment. Surgical options included primary repair (D group, 12 cases), segmental resection (S group, 5 cases) and right hemicolectomy (H group, 9 cases). The length of postoperative stay, complications, and body weight growth in body weight percentile curve chart at last follow-up visit in each group were compared by analysis of variance. RESULTS Of the 26 patients who underwent the right colon perforation treatment, cecum perforation was found in 16 (62%), ascending colon perforation in six (23%), transverse colon perforation in three (12%), and combined ascending and transverse colon in one (4%). No mortality or anastomotic leakage occurred. The mean length of postoperative stay was shorter in the D group than in the S and H groups but without statistical significance (mean 10.9 days vs. 11.6 days and 17.9 days, respectively). Long-term body weight growth was significantly better in the D group (+26.3 ± 22.2 percentile) than the H group (-4.8 ± 8.0 percentile; p = 0.02). CONCLUSION For right colon perforation in children, simple closure following debridement has long-term benefits over more extensive resections.
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Affiliation(s)
- Chau-Jing Chen
- Section of Pediatric Surgery, Department of Surgery, National Cheng-Kung University Hospital, Tainan, Taiwan
| | - Jen-Pin Chuang
- Surgery Department, Sin-Hua Branch, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan; Institute of Clinical Medicine, National Cheng Kung University College of Medicine, Tainan, Taiwan.
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Cho YH, Kim HY, Kim SH, Byun SY, Park KH, Han YM. Gastric Perforation in the Neonatal Period: Differences between Preterm and Term Infants. NEONATAL MEDICINE 2015. [DOI: 10.5385/nm.2015.22.3.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Yong Hoon Cho
- Division of Pediatric Surgery, Department of Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Hae Young Kim
- Division of Pediatric Surgery, Department of Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Soo Hong Kim
- Division of Pediatric Surgery, Department of Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Shin Yun Byun
- Division of Neonatology, Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Kyung Hee Park
- Division of Neonatology, Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Young Mi Han
- Division of Neonatology, Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
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Byun J, Kim HY, Noh SY, Kim SH, Jung SE, Lee SC, Park KW. Neonatal gastric perforation: A single center experience. World J Gastrointest Surg 2014; 6:151-155. [PMID: 25161763 PMCID: PMC4143970 DOI: 10.4240/wjgs.v6.i8.151] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/23/2014] [Accepted: 07/14/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the etiology and prognostic factors for neonatal gastric perforation (NGP), a rare but life-threatening disease.
METHODS: Between 1980 and 2011, nine patients underwent surgical intervention for NGP at Seoul National University Children’s Hospital. The characteristics and prognosis of the patients were retrospectively analyzed.
RESULTS: Among the nine patients, three (33.3%) were preterm babies and five (55.5%) had associated anomalies, which included diaphragmatic eventration (n = 2), congenital diaphragmatic hernia, esophageal atresia with tracheoesophageal fistula, and antral web. Three (33.3%) patients were born before 1990 and three (33.3%) had a birth weight < 2500 g. Pneumoperitoneum was found on preoperative images in six (66.7%) patients, and incidentally in the other three (33.3%) patients. Surgery was performed within 24 h after the onset of symptoms in seven (77.8%) patients. The overall mortality rate was 22.2% (2/9). The time between symptoms and surgical intervention was the only prognostic factor for survival, whereas premature birth and birth weight were not.
CONCLUSION: Early detection and advances in neonatal intensive care may improve the prognosis of NGP.
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Spontaneous cecal perforation secondary to acute fulminant gastroenteritis. ANNALS OF PEDIATRIC SURGERY 2014. [DOI: 10.1097/01.xps.0000437373.44829.cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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18
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Talishinskiy T, Tomita S. Intestinal perforation in preterm infant as an unusual initial presentation of Hirschsprung's disease. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Gupta G, Kumar S, Gupta S, Golhar KB, Deshpande S. Neonatal gastric perforations: are they really spontaneous? Indian J Surg 2013; 76:319-20. [PMID: 25278658 DOI: 10.1007/s12262-013-0980-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 09/16/2013] [Indexed: 11/28/2022] Open
Abstract
CASE REPORT We report a case of 4-day-old male infant who developed rapid abdominal distension with progression to shock. Abdominal radiography showed free gas under diaphragm for which emergency laparotomy was done revealing a perforation in the greater curvature of the stomach that was sutured after excising surrounding ischemic stomach wall.
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Affiliation(s)
- Gaurav Gupta
- Department of Surgery, Maharishi Markandeshwar Institute of Medical Sciences & Research, Mullana, Ambala, Haryana India
| | - Sachin Kumar
- Department of Surgery, Maharishi Markandeshwar Institute of Medical Sciences & Research, Mullana, Ambala, Haryana India
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Shukri N, Amara R, Malik S, Taher H, Kilany M. Neonatal intestinal perforation-a rare complication of small bowel hemangioma. European J Pediatr Surg Rep 2013; 1:30-1. [PMID: 25755946 PMCID: PMC4335917 DOI: 10.1055/s-0033-1337110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 12/04/2012] [Indexed: 11/19/2022] Open
Abstract
Intestinal perforation is an extremely rare complication of hemangioma of the small intestine in the neonatal period. This is a case report of a 27-days-old male infant who presented with signs and symptoms of acute intestinal obstruction. Exploratory laparotomy findings revealed intestinal perforation due to solitary hemangioma in the ileum, which led to obstruction from peritoneal reaction and adhesions. There are two reported cases in the literature presenting with ileal perforation in the pediatric age group, but only one previous report mentioned in the neonatal period. Because there are other more common causes of perforation in the neonatal period, intestinal hemangioma in spite of its rarity should be included in the differential diagnosis.
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Affiliation(s)
- Nasser Shukri
- Department of Pediatric Surgery, Maternity and Children's Hospital, Jeddah, Saudi Arabia
| | - Ridha Amara
- Department of Pediatric Surgery, Maternity and Children's Hospital, Jeddah, Saudi Arabia
| | - Shakeel Malik
- Department of Pediatric Surgery, Maternity and Children's Hospital, Jeddah, Saudi Arabia
| | - Hanan Taher
- Department of Pediatric Surgery, Maternity and Children's Hospital, Jeddah, Saudi Arabia
| | - Mansour Kilany
- Department of Pediatric Surgery, Maternity and Children's Hospital, Jeddah, Saudi Arabia
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21
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Linder N, Hammel N, Hernandez A, Fridman E, Dlugy E, Herscovici T, Klinger G. Intestinal perforation in very-low-birth-weight infants with necrotizing enterocolitis. J Pediatr Surg 2013; 48:562-7. [PMID: 23480913 DOI: 10.1016/j.jpedsurg.2012.08.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 08/19/2012] [Accepted: 08/20/2012] [Indexed: 02/01/2023]
Abstract
PURPOSE To identify risk factors for intestinal perforation in very-low-birth-weight (VLBW) infants with necrotizing enterocolitis (NEC). METHODS Retrospective case-control study over a 10-year period, using univariate and multivariate logistic regression analyses to compare all VLBW infants treated for perforated NEC, with two age and weight-matched groups: infants with non-perforated NEC and infants without NEC. RESULTS Twenty infants with perforated NEC were matched to 20 infants with non-perforated NEC and 38 infants without NEC. Infants with perforated NEC were younger (p<0.01) and had higher rates of abdominal distention, metabolic acidosis, hyperglycemia and elevated liver enzymes (p<0.05). On logistic regression analysis, abdominal distention was associated with an increased risk of intestinal perforation (OR 39.8, 95% CI 2.71-585) and late onset of NEC (one-day increments) was associated with a decreased risk (OR 0.93, 95% CI 0.87-1.0). CONCLUSION Identification of abdominal distention at an early age in VLBW infants should lead to increased vigilance for signs of perforated NEC and may enable early intervention.
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Affiliation(s)
- Nehama Linder
- Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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22
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Terui K, Iwai J, Yamada SI, Takenouchi A, Nakata M, Komatsu S, Yoshida H. Etiology of neonatal gastric perforation: a review of 20 years' experience. Pediatr Surg Int 2012; 28:9-14. [PMID: 22009207 DOI: 10.1007/s00383-011-3003-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Gastric perforation (GP) of the newborn is a rare, serious, and life-threatening problem, and its etiology remains unclear. Although historically GP has often been described as "spontaneous'', some cases are non-spontaneous. The aim of the present study was to review cases of GP and to discuss its etiology in a single prefecture in Japan over a period of 20 years. METHODS Eleven cases with GP that underwent surgery in 4 institutions in the Chiba Prefecture from 1991 to 2010 were reviewed and divided into 2 groups: the early (1991-2000, n = 7) and late (2001-2010, n = 4) groups. RESULTS No factors were observed that could have caused GP other than malformations associated with distal obstruction (3 midgut volvulus, 1 jejunal stenosis, 1 diaphragm eventration). Distal obstruction was present in 1 case in the early group and all 4 cases in the late group (p = 0.015). While the incidence of GP did not change over the 20-year period reviewed, the incidence of GP without distal obstruction significantly decreased in the late group. CONCLUSION The proportion of patients with GP and distal obstruction increased and true "spontaneous" cases of GP decreased over time. The possible presence of distal obstruction should be evaluated during surgery for GP.
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Affiliation(s)
- Keita Terui
- Department of Pediatric Surgery, Matsudo City Hospital Children's Medical Center, 4005 Kamihongo, Matsudo, Chiba, 271-8511, Japan.
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23
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Oh BY, Choi KJ. Prognostic Factors of Surgically Treated Pneumoperitoneum in Neonates. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.77.2.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Bo-young Oh
- Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kum-ja Choi
- Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea
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24
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Gillies MJ, Chowdhury MM, Lakhoo K. A pitfall in the interpretation of plain abdnominal radiographs in neonatal intestinal perforation: a case report. J Med Case Rep 2008; 2:335. [PMID: 18957086 PMCID: PMC2584007 DOI: 10.1186/1752-1947-2-335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Accepted: 10/28/2008] [Indexed: 11/18/2022] Open
Abstract
Introduction The recognition of neonatal intestinal perforation relies on identification of free gas in the peritoneum on plain abdominal radiographs and the associated clinical signs. The neonatal bowel takes several hours to fill with gas, potentially obscuring one of the radiological signs of bowel perforation in the neonate. Case presentation We describe the case of a male, Caucasian neonate, born prematurely at 35+2 weeks of gestation, who was suspected before birth to be at risk of intestinal perforation, based on antenatal ultrasound signs of bowel obstruction. However, the diagnosis of intestinal perforation after birth was initially delayed because the first abdominal radiograph, requested by the neonatal team, was taken too early in the clinical progression of the neonate's condition. As a consequence, this delayed referral to the paediatric surgical team and definitive management. Conclusion This case illustrates how consideration of the timing of abdominal radiographs in suspected intestinal perforation in the neonate may avoid misinterpretation of radiographic signs, thereby avoiding delays in referral and treatment in the crucial first few hours of life.
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Affiliation(s)
- Martin J Gillies
- Children's Hospital Oxford, John Radcliffe Hospital, Headley Way, Oxford, UK.
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Duran R, Inan M, Vatansever U, Aladağ N, Acunaş B. Etiology of neonatal gastric perforations: review of 10 years' experience. Pediatr Int 2007; 49:626-30. [PMID: 17875089 DOI: 10.1111/j.1442-200x.2007.02427.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neonatal gastric perforation (NGP) is a rare event and its etiology is still controversial. Although it has previously been described as spontaneous, recently some risk factors have been reported to be associated with the development of NGP including prematurity and nasal ventilation. The purpose of the present paper was to report and discuss etiology, clinical features, and outcome of the authors' NGP cases over a 10 year period. METHODS Charts of five infants with NGP was reviewed in terms of gender, birthweight, gestational age, time of diagnosis, associated disease, site of perforation, type of surgery performed, and clinical outcome. RESULTS There were three boys and two girls with a mean birthweight and gestational age of 1650 g and 32 weeks, respectively. Three of them were premature. Mean perforation time was day 10 postnatally. Three infants had associated problems including prematurity, respiratory distress syndrome type 1, necrotizing enterocolitis, mechanical ventilator support, and one of them had tracheaesophageal fistula. Mothers of two out of these three infants had chorioamnionitis. One full-term infant received dexamethasone because of brain edema. Only one patient had no associated problem. Perforation occurred in the lesser curvature in three infants and in the greater curvature in two infants. Mortality rate was 60%. CONCLUSIONS Contrary to previous literature, and similar to recent publications, it was found that essentially low-birthweight infants with tracheaesophageal fistula or chorioamnionitis and full-term babies on steroid therapy may have a risk for NGP, suggesting that an infant with contributing factors should be monitored more carefully for the development of NGP.
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Affiliation(s)
- Ridvan Duran
- Department of Pediatrics, Trakya University Faculty of Medicine, Edirne, Turkey.
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26
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Chiu B, Pillai SB, Almond PS, Beth Madonna M, Reynolds M, Luck SR, Arensman RM. To drain or not to drain: a single institution experience with neonatal intestinal perforation. J Perinat Med 2007; 34:338-41. [PMID: 16856827 DOI: 10.1515/jpm.2006.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS The optimal surgical treatment for extremely-low-birth-weight (ELBW) neonates with pneumoperitoneum is controversial. This study aimed to identify clinical factors associated with two known causes of pneumoperitoneum-necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP), and assesses the treatment outcome with primary peritoneal drainage (PPD) vs. laparotomy. METHODS We reviewed and analyzed clinical characteristics and outcome from records of neonates with pneumoperitoneum treated at our institution from January 1999 to January 2003. RESULTS Forty-six neonates (31 NEC, 15 SIP) were treated with either PPD (20 with NEC, 13 with SIP) or laparotomy (11 with NEC, 2 with SIP). In neonates who underwent PPD, those with NEC (vs. SIP) were less likely to have a patent ductus arteriosus, but were more likely to have been fed, have drains placed later in life, have a subsequent laparotomy, a longer total parental nutrition course, a higher 30-day mortality, and to take more days to begin enteral feeds. CONCLUSION The etiology of pneumoperitoneum (NEC vs. SIP) in ELBW neonates can usually be determined preoperatively. Neonates with SIP should have a drain placed while those with NEC should undergo laparotomy.
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Affiliation(s)
- Bill Chiu
- Children's Memorial Hospital, 2300 Children's Plaza, Box 63, Chicago, IL 60614, USA
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Chang YJ, Yan DC, Kong MS, Chao HC, Huang CS, Lai JY. Non-traumatic colon perforation in children: a 10-year review. Pediatr Surg Int 2006; 22:665-9. [PMID: 16821019 DOI: 10.1007/s00383-006-1723-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2006] [Indexed: 11/29/2022]
Abstract
Colon perforation is an abdominal surgical emergency in the pediatric population, but is seldom reported when occurring from non-traumatic causes in children beyond the neonate. The goal of this study was to identify the clinical characteristics, management, and outcomes of non-traumatic colon perforation in children. Medical records for the 10-year period from September 1994 to September 2004 were reviewed for children beyond the neonate with non-traumatic colon perforation. Data gathered included age, gender, symptoms, duration of symptoms, physical findings, and length of postoperative hospital stay. Diagnostic information included laboratory data, radiographic imaging, and operative findings. Forty-four patients with non-traumatic colon perforation were recruited into this study. The mean age was 2.22 +/- 1.87 years; 91.4% of cases were younger than 5 years old. The most common presenting symptom was fever (97.7%); the most common sign was abdominal distention (93.1%). The mean duration of symptoms prior to admission was 6.19 days. Pneumoperitoneum was presented in 86.3% of patients by plain abdominal radiograph. Ascending and transverse colon were the most common perforation sites. Non-typhoid salmonella was the leading pathogen isolated, causing 20.4% of episodes. One case died due to Clostridium speticum infection. Non-traumatic colon perforation most commonly affects children younger than 5 years of age. It may be secondary to infection, especially non-typhoid salmonella. Plain abdominal radiograph can be an adjuvant tool for the high index of suspicion for colon perforation in children with abdominal distention and history of fever or diarrhea for more than 5 days.
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Affiliation(s)
- Y J Chang
- Department of pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine or Chang Gung Institute of Technology, Chang Gung Children's Hospital, Kwei-Shan, Taoyuan, Taiwan
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Abstract
BACKGROUND Gastric perforation is a rare, life-threatening condition in neonates. To avoid deterioration, prompt surgical treatment is mandatory. PATIENTS We report on 2 neonates (1 and 8 days old) with feeding tube associated gastric perforation managed laparoscopically by single layer suture repair. Both children suffered from severe peritonitis. Operative time was 60 minutes in both cases. Oral feeding was started on postoperative day 3 and 7, respectively. No complications regarding the gastric perforation were encountered on follow-up (11 and 8 months, respectively) in both cases. CONCLUSIONS We recommend laparoscopic suture repair as a safe and feasible method for surgical treatment of gastric perforation in neonates. These appear to be the first reported cases using this procedure for treatment of neonatal gastric perforation.
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Affiliation(s)
- Sylvia Glüer
- Department of Pediatric Surgery, Hannover Medical School, D-30623 Hannover, Germany.
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29
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Karunakara BP, Ananda Babu MN, Maiya PP, Prashanth S, Suni I. Nasogastric feeding tube gastric perforation in a neonate. Indian J Pediatr 2004; 71:661-2. [PMID: 15280620 DOI: 10.1007/bf02724132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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30
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Hwang H, Murphy JJ, Gow KW, Magee JF, Bekhit E, Jamieson D. Are localized intestinal perforations distinct from necrotizing enterocolitis? J Pediatr Surg 2003; 38:763-7. [PMID: 12720189 DOI: 10.1016/jpsu.2003.50162] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/PURPOSE Localized intestinal perforation (LP) is thought to be a distinct entity when compared with perforation associated with necrotizing enterocolitis (NEC). Studies have indicated that LP is more amenable to percutaneous drainage and associated with a better outcome. We sought to determine whether LP and NEC could be distinguished based on clinical parameters alone. METHODS A retrospective review of 40 neonates with gastrointestinal perforations between January 1990 and May 1998 was performed. All had undergone laparotomy and had histologic specimens available for evaluation. RESULTS Twenty-one neonates had necrotizing enterocolitis (NEC), and 19 had localized perforation (LP) based on histologic criteria. More neonates with LP were exposed to prenatal indomethacin (37% v 5%; P <.05), received intravenous dexamethasone (42% v 10%; P <.05), had umbilical artery catheters (63% v 14%; P <.05), and had a higher white blood cell (WBC) count (27.1 +/- 23.1 v 14.3 +/- 11.5; P <.05). More neonates with NEC had pneumatosis intestinalis (47% v 11%; P <.05). No significant differences existed in enteral feeding (16% LP v 38% NEC) or overall mortality rate (37% LP v 38% NEC). No statistical differences in the timing of perforation or clinical presentation were found. CONCLUSIONS NEC and LP are difficult to distinguish based on clinical parameters alone. The authors did find associations between LP and prenatal indomethacin, intravenous dexamethasone, umbilical artery catheters, and a higher WBC count. Mortality rate and clinical outcome were nearly identical in both groups. Pneumatosis intestinalis, thought to be pathognomonic for NEC, was seen on abdominal radiograph in 2 babies with histologically proven LP.
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Affiliation(s)
- Hamish Hwang
- Departments of Pediatric Surgery, Pathology, and Radiology, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada
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31
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Chen JC, Chen CC, Liang JT, Huang SF. Spontaneous bowel perforation in infants and young children: a clinicopathologic analysis of pathogenesis. J Pediatr Gastroenterol Nutr 2000; 30:432-5. [PMID: 10776957 DOI: 10.1097/00005176-200004000-00016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND In children beyond the neonatal stage, spontaneous bowel perforation with no specific cause is rare. It has attracted little notice and does not fit into any established clinical category. This often results in treatment delays. To determine the underlying pathogenesis, a clinicopathologic analysis of this group of patients was performed. METHODS From 1984 through 1997, 15 previously healthy children (10 boys and 5 girls) with bowel perforations were enrolled in this study. Children in whom the specific cause was established were excluded. The ages of the patients ranged from 3 months to 5 years, 5 months (average age: 2 years, 4 months). Data on clinical course, surgical and pathologic findings, and outcomes were analyzed. RESULTS All the patients had high fever and acute, watery diarrhea with clinical dehydration. Abdominal distension developed and bowel perforation ensued 5 to 30 days after the onset of diarrhea. In all cases, the perforation consisted of either an isolated patch of bowel (n = 8) or patchy lesions in a segment (n = 7), which was confined to one of the following three anatomic watershed areas: the splenic flexure (n = 7); the lower sigmoid (n = 3); and the ileocecal region (n = 5). One patient died, and three had major sequelae including intra-abdominal abscess, adhesion ileus, and peristomal fistula. Specimens from 13 patients were submitted for histopathologic evaluation. All specimens had acute suppurative inflammation diffusely around the perforation site. Seven had areas of coagulation necrosis of the muscularis propria, especially in the inner circular muscle layer. CONCLUSION In acute diarrheal diseases, dehydration may cause bowel ischemia and lead to perforation. Physicians should be alert to the possibility of this abdominal catastrophe when progressive abdominal distension followed by acute diarrheal episodes occurs in children.
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Affiliation(s)
- J C Chen
- Department of Surgery, Chang Gung Children's Hospital, Chang-Gung University College of Medicine, Taipei, Taiwan
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Abstract
This report describes a newborn infant girl who presented with abdominal distension and pneumoperitoneum. At operation, near total necrosis of the stomach was observed. The esophagus was ligated, the stomach resected. The baby was fed by an transpyloric feeding tube. At 8 weeks, an esophagojejunal anastomosis was performed with a Hunt-Lawrence Pouch. A good outcome was achieved.
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Affiliation(s)
- M M Durham
- Egleston Children's Hospital, Emory University, Atlanta, GA, USA
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33
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Affiliation(s)
- R P Foglia
- Washington University School of Medicine, St. Louis Children's Hospital, Missouri, USA
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34
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Abstract
There are few reports of gastrocolic fistula in infancy. Our observations on the clinical course of this condition are presented. The diagnostic possibilities and surgical procedure are discussed.
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Affiliation(s)
- J Hager
- Department of Pediatric Surgery, I. University Hospital for Surgery, Innsbruck, Austria
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