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Spontaneous Intestinal Perforation: The Long-Term Outcome
16 June 2016
20 September 2016
15 November 2016 (online)
Background/Purpose Evaluating the long-term outcome of spontaneous intestinal perforation (SIP).
Methods We studied all patients treated for SIP at our institution between January 1, 2005 and December 31, 2014.
Results Twenty-three infants (13 males) with a median gestational age of 26 (range: 23–32) weeks and a median weight of 825 (range: 560–1,965) g composed this cohort. Seventeen (74%) infants had an extremely low birth weight (ELBW); nine (39%) infants were the result of multiple pregnancies.
Patent ductus arteriosus (PDA) was present in 16 (70%) infants. Cyclooxygenase inhibitors were administered in 12 (52%) infants.
Ten infants (seven males, 44%) were diagnosed with intraventricular hemorrhage (IVH), which was identified in the majority (8/10) at a median of 9 (range: 1–11) days prior to the perforation.
All patients presented with pneumoperitoneum and underwent a laparotomy at a median age of 9 (range: 2–16) days. Twenty-one patients had an ileal perforation. A temporary stoma was placed in 21 patients, whereas two got primary anastomosis. Two (8.7%) male infants died. During the long-term follow-up period (median 6 years), six (five males) (26%) infants developed moderate to severe disabilities in combination with cerebral palsy. No surgical complications were observed.
Conclusion The most important risk factor for SIP is ELBW (75%). The distal ileum is the most frequent site of perforation (88%). Approximately 40% develop IVH most often prior to the SIP. Moderate to severe neurologic disabilities are seen in more than a quarter of the children. Disability and mortality affect mostly the male sex. Long-term risks of surgical complications are very low.
- 1 Chan KYY, Leung KT, Tam YH. , et al. Genome-wide expression profiles of necrotizing enterocolitis versus spontaneous intestinal perforation in human intestinal tissues: dysregulation of functional pathways. Ann Surg 2014; 260 (06) 1128-1137
- 2 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (04) 529-534
- 3 Tortorolo G, Luciano R, Papacci P, Tonelli T. Intraventricular hemorrhage: past, present and future, focusing on classification, pathogenesis and prevention. Childs Nerv Syst 1999; 15 (11–12): 652-661
- 4 Marlow N, Wolke D, Bracewell MA, Samara M. ; EPICure Study Group. Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med 2005; 352 (01) 9-19
- 5 Zamir O, Goldberg M, Udassin R, Peleg O, Nissan S, Eyal F. Idiopathic gastrointestinal perforation in the neonate. J Pediatr Surg 1988; 23 (04) 335-337
- 6 Buchheit JQ, Stewart DL. Clinical comparison of localized intestinal perforation and necrotizing enterocolitis in neonates. Pediatrics 1994; 93 (01) 32-36
- 7 Uceda JE, Laos CA, Kolni HW, Klein AM. Intestinal perforations in infants with a very low birth weight: a disease of increasing survival?. J Pediatr Surg 1995; 30 (09) 1314-1316
- 8 Adderson EE, Pappin A, Pavia AT. Spontaneous intestinal perforation in premature infants: a distinct clinical entity associated with systemic candidiasis. J Pediatr Surg 1998; 33 (10) 1463-1467
- 9 Pumberger W, Mayr M, Kohlhauser C, Weninger M. Spontaneous localized intestinal perforation in very-low-birth-weight infants: a distinct clinical entity different from necrotizing enterocolitis. J Am Coll Surg 2002; 195 (06) 796-803
- 10 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 (05) 763-767
- 11 Meyer CL, Payne NR, Roback SA. Spontaneous, isolated intestinal perforations in neonates with birth weight less than 1,000 g not associated with necrotizing enterocolitis. J Pediatr Surg 1991; 26 (06) 714-717
- 12 Mintz AC, Applebaum H. Focal gastrointestinal perforations not associated with necrotizing enterocolitis in very low birth weight neonates. J Pediatr Surg 1993; 28 (06) 857-860
- 13 von Siebold AE. Sechster Bericht über die Entbindungsanstalt der königlichen Universität zu Berlin und der damit in Verbindung stehenden Poliklink für Geburtshülfe Frauenzimmer- und neugeborner Kinder-Kankheiten vom Jahre 1823 A. Geburtshülfliche Klinik Frankfurt am Main. Journal für Geburtshülfe Frauenzimmer- und Kinderkrankheiten (Sixth report on the Maternity Hospital of the Royal University of Berlin and its Polyclinic for Obstetrics, Gynecology and Neonatology from 1823 A. Obstetric Clinic Frankfurt am Main. J Obstet, Gynecol & Pediat). 1825; 5 (01) 1-33
- 14 Johnston PG, Gillam-Krakauer M, Fuller MP, Reese J. Evidence-based use of indomethacin and ibuprofen in the neonatal intensive care unit. Clin Perinatol 2012; 39 (01) 111-136
- 15 Hammerman C. Patent ductus arteriosus. Clinical relevance of prostaglandins and prostaglandin inhibitors in PDA pathophysiology and treatment. Clin Perinatol 1995; 22 (02) 457-479
- 16 Nagaraj HS, Sandhu AS, Cook LN, Buchino JJ, Groff DB. Gastrointestinal perforation following indomethacin therapy in very low birth weight infants. J Pediatr Surg 1981; 16 (06) 1003-1007
- 17 Fowlie PW, Davis PG, McGuire W. Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants. Cochrane Database Syst Rev 2010; 7 (07) CD000174
- 18 Lai S, Yu W, Wallace L, Sigalet D. Intestinal muscularis propria increases in thickness with corrected gestational age and is focally attenuated in patients with isolated intestinal perforations. J Pediatr Surg 2014; 49 (01) 114-119
- 19 Colver A, Fairhurst C, Pharoah PO. Cerebral palsy. Lancet 2014; 383 (9924): 1240-1249
- 20 Ballabh P. Intraventricular hemorrhage in premature infants: mechanism of disease. Pediatr Res 2010; 67 (01) 1-8
- 21 Cass DL, Brandt ML, Patel DL, Nuchtern JG, Minifee PK, Wesson DE. Peritoneal drainage as definitive treatment for neonates with isolated intestinal perforation. J Pediatr Surg 2000; 35 (11) 1531-1536
- 22 Lessin MS, Luks FI, Wesselhoeft Jr CW, Gilchrist BF, Iannitti D, DeLuca FG. Peritoneal drainage as definitive treatment for intestinal perforation in infants with extremely low birth weight (<750 g). J Pediatr Surg 1998; 33 (02) 370-372
- 23 Rovin JD, Rodgers BM, Burns RC, McGahren ED. The role of peritoneal drainage for intestinal perforation in infants with and without necrotizing enterocolitis. J Pediatr Surg 1999; 34 (01) 143-147
- 24 Sola JE, Tepas III JJ, Koniaris LG. Peritoneal drainage versus laparotomy for necrotizing enterocolitis and intestinal perforation: a meta-analysis. J Surg Res 2010; 161 (01) 95-100
- 25 Kraemer S. The fragile male. BMJ 2000; 321 (7276): 1609-1612
- 26 Fitzgibbons SC, Ching Y, Yu D. , et al. Mortality of necrotizing enterocolitis expressed by birth weight categories. J Pediatr Surg 2009; 44 (06) 1072-1075 , discussion 1075–1076
- 27 Henry MCW, Moss RL. Necrotizing enterocolitis. In: Stringer M, Oldham K, Mouriquand P. , eds. Pediatric Surgery and Urology: Long-Term Outcomes. 2nd ed. Cambridge, UK: Cambridge University Press; 2006: 329-350 : chap 26
- 28 Houben CH, Chan KWE, Mou JWC, Tam YH, Lee KH. Management of intestinal strictures post conservative treatment of necrotizing enterocolitis: The long term outcome. J Neonatal Surg 2016; 5 (03) 28 ; doi: 102199/jns.v5i3.374