Etiology and surgical management of pediatric acute colon perforation beyond the neonatal stage

Abstract

Purpose Acute colon perforation is a pediatric surgical emergency. We aimed to analyze the different etiologies and clinical characteristics of acute non-traumatic colon perforation beyond the neonatal period and to identify surgical management and outcomes. Methods This retrospective study included 18 patients admitted with acute colon perforation and who received surgical treatment. Results Age of patients ranged between 1 month and 15 years. Five patients swallowed foreign objects (two swallowed magnets), two had colon perforation secondary to a malignant tumor (both colorectal adenocarcinoma) and two were iatrogenic (one prior colonoscopy, one air enema for intussusception). There was one perforation due to chemotherapy and Amyand’s hernia respectively. The remaining seven patients had unknown etiologies; five of them were diagnosed with colitis. Fifteen (83.3 %) patients underwent open laparotomy, among which four attempted laparoscopy first. Three (16.7 %) patients underwent laparoscopic surgery. Fourteen (77.8 %) patients received simple suture repairs and four (22.2 %) received colonic resections and anastomosis. Four (22.2 %) patients received a protective diverting colostomy and three (16.7 %) received an ileostomy. Conclusions There is a wide range of etiology besides necrotizing enterocolitis and trauma, but a significant portion of children present with unknown etiology. Type of surgery elected should be dependent on the patient’s etiology, disease severity and experience of surgeons.

Primary intestinal anastomosis in a child with perforation of Meckel’s diverticulum and peritonitis

“…Опубликованы работы, свидетельствующие о преимуществах тактики ПКА в сравнении с формированием кишечной стомы у детей со спонтанной перфорацией тонкой кишки [15,16]. А Sarah Tan et al опубликовали хорошие результаты лечения пациентов с острой перфорацией ободочной кишки различного генеза, которым выполняли резекцию кишки с формированием ПКА несмотря на условия перитонита [17]. Первичное анастомозирование кишки в условиях воспалительного процесса в брюшной полости и бактериальной обсемененности успешно применяется у пациентов с травматическим повреждением кишки вследствие проглатывания нескольких магнитных инородных тел [18].…”

Spontaneous Intestinal Perforation in Neonates Involving the Cecum: A Case Report

“…Hirschsprung disease is perhaps the only condition where a routine correlation to a cecum perforation has been made in case studies [ 1 , 2 , 4 ]. The incidence of 3%-4% is, however, largely seen in long‑segment Hirschsprung disease.…”

“…The morbidity of these patients remains high, with the stoma output needing extensive resuscitation and intensive care unit care. In spite of efforts, the mortality rate in most studies is close to 50% [ 1 , 2 , 6 ]. The patient had a spectacular outcome and is growing well after the completion of surgical treatment.…”

“…In preterm infants, colonic perforation is caused mostly due to necrotizing enterocolitis (NEC). It may be associated with Hirschsprung disease, small left colon syndrome, meconium plug syndrome, idiopathic perforations, anorectal malformations, stercoral perforations, and cystic fibrosis [1][2][3]. In term and near-term infants, Hirschsprung disease is the leading cause, followed by NEC and spontaneous idiopathic perforation [1][2][3][4].…”

“…It may be associated with Hirschsprung disease, small left colon syndrome, meconium plug syndrome, idiopathic perforations, anorectal malformations, stercoral perforations, and cystic fibrosis [1][2][3]. In term and near-term infants, Hirschsprung disease is the leading cause, followed by NEC and spontaneous idiopathic perforation [1][2][3][4]. Bowel perforation that develops idiopathically otherwise known as spontaneous intestinal perforation has no known cause.…”