Comparison of gastric and other bowel perforations in preterm infants: a review of 20 years' experience in a single institution

Abstract

PurposeIn this study, we aimed to review the clinical presentation of preterm infants with gastrointestinal perforations and compare the clinical features of gastric perforation with other intestinal perforations.MethodsThe medical records of preterm neonates with pneumoperitoneum, admitted to the neonatal intensive care unit (NICU) between January 1994 and December 2013, were retrospectively reviewed.ResultsTwenty-one preterm infants underwent exploratory laparotomy to investigate the cause of the pneumoperitoneum. The sample consisted of five patients (23.8%) with gastric perforation and 16 patients (76.2%) with intestinal perforation. No statistical differences were found in the birth history and other perinatal factors between the two groups. Underlying necrotizing enterocolitis, bilious vomiting, and paralytic ileus preceding the perforation were statistically more common in the intestinal perforation group. All preterm infants with gastric perforation survived to discharge; however, six preterm infants with intestinal perforation expired during treatment in the NICU. In the gastric perforation group, sudden pneumoperitoneum was the most common finding, and the mean age at diagnosis was 4.4±1.7 days of life. The location and size of the perforations varied, and simple closure or partial gastrectomy was performed.ConclusionPatients with gastric perforation did not have a common clinical finding preceding the perforation diagnosis. Although mortality in previous studies was high, all patients survived to discharge in the present study. When a preterm infant aged less than one week presents with sudden abdominal distension and pneumoperitoneum, gastric perforation should first be excluded. Prompt exploratory laparotomy will increase the survival rates of these infants.

Neonatal gastro-intestinal tract perforation in Mosul city

“…The birth weights of patients were ranged from 1500 to 3600 g. Gestational age of patients ranged from 30 to 40 weeks with an average of 36.03 ± 2.736 and the presentation-surgical intervention interval was 1-6 days (2.0±1.1). The predominance of males was clear in the current research and corresponding to findings of other works 18,19 , although the results of another research 17 showed increase in female percentage 15 (44.1%), the males still higher 19 (55.9%). The site of perforation showed a discrepancy from the esophagus extending to the colon, and the most frequent site in the present study was small intestine which corresponding to the pediatric literature, in which, the frequent site of GIP was the small bowels, and the distal ileum was the predominant [20][21][22] .…”

Pediatric gastric perforation beyond neonatal period: 8-year experience with 20 patients

“…After retrospectively analyzing the clinical data, we found that most patients had a spontaneous gastric perforation, which was in accordance with other case reports. 8,16,17 Helicobacter pylori infection is thought to be highly associated with peptic ulcers, which might induce gastric perforation. However, gastric ulcer-induced perforation is uncommon in pediatric patients.…”

Gastric Perforation: Postmortem Diagnosis

“…It is noteworthy that it is a full-term child of good weight, unlike most children who are affected by this pathology. Lee reviewed premature infants with perforations of the gastrointestinal tract, comparing gastric perforation with other sites [10]. He found five patients with gastric perforation and 11 with intestinal perforation.…”