Clinical implication of spontaneous gastrointestinal perforation in pediatric patients: its difference according to age group

Abstract

PurposeSpontaneous gastrointestinal perforations (SGIPs; not associated with injury or disease) occur rarely in pediatric patients. This study aimed to define age-specific features associated with SGIPs in pediatric patients.MethodsRetrospectively reviewed the clinical data of children (before adolescence) who received surgery due to a SGIP at a single institution. Thirty-nine patients were enrolled. Characteristics were compared between the 2 age groups: neonates (group A) and beyond neonates (group B).ResultsGroup A included 24 patients (61.5%) an group B included 15 patients (38.5%). Thirteen perforations occurred in the stomach (33.3%), 12 in the small intestine (30.8%), and 14 in the large intestine (35.9%). A significantly higher proportion of perforations occurred in the stomach and small intestine in group A, while more perforations occurred in the large intestine in group B (P = 0.01). Several associated conditions during the preoperative period were identified in both groups. The overall mortality rate was 15.4% (6 of 39). Mortality was relatively high in group A (5 of 24, 20.8%) and for perforations of stomach (3 of 13, 23.1%) and small intestine (3 of 12, 25.0%); however, there were no significant differences with regard to age or perforation site (P = 0.244, P = 0.122, respectively).ConclusionSGIPs in pediatric patients had diverse clinical features and different perforation patterns according to age group. However, no significant group differences in mortality were found. Thus, favorable results regardless of age can be expected with prompt recognition, medical resuscitation, and adequate surgical management.

Spontaneous Gastric Perforation in a Child and Endoscopic Balloon Dilation for Postoperative Gastric Stenosis

“…Congenital causes of spontaneous gastric perforation in differing age groups from premature newborns to adolescents include gastric volvulus, diaphragmatic hernia with strangulation, duodenal atresia, and duplication; acquired causes comprise of caustic (usually acidic) or foreign body (button battery, sharp objects, and magnets) ingestion, peptic ulcer, stress (burns, spinal cord injuries, and Curling's ulcer), infection (rotavirus, norovirus, cytomegalovirus, tuberculosis, strongyloidosis, coronavirus 19, and fungal), trauma (blunt, physical abuse, and cardiopulmonary resuscitation), and iatrogenic (medications like non‐steroidal anti‐inflammatory drugs, nasogastric tube placement, surgery—gastrostomy tube migration, and postpyloromyotomy). 10 There is a broader range of rare causes that encompasses systemic vasculitides, connective tissue disorders, SLC2A10 mutation causing arterial tortuosity syndrome, eosinophilic gastroenteritis, anorexia nervosa, and neoplastic tumors. Spontaneous small and large bowel perforations from ischemic necrosis and ulceration have been described in a few children with PAN 11.…”