Perforation of the Gastrointestinal Tract of the Newborn Infant

Abstract

The medical literature has many excellent case reports and several good treatises on perforation of the gastrointestinal tract of the newborn infant, but the articles are scattered in specialized journals, or the cases are listed under such obscure titles in the indexes (peptic ulcer, fetal peritonitis, melena neonatorum, pneumoperitoneum or meconium peritonitis) that it is a tedious procedure even to locate the references. I have attempted to bring together in the accompanying table all of the cases of spontaneous perforation regardless of cause, but in view of the varied approaches to the condition 1 or more cases may have been overlooked. Cases of perforation associated with definite obstruction of the bowel, intrinsic or extrinsic, are not included ; cases of intrauterine rupture of the appendix have also been omitted (Abt,1 Jackson,2 Hill and Mason3).Perusal of the literature also revealed that authors differed in their interpretations of what constitutes a rupture. In some series are included cases of ulceration through the layers of the bowel, whether or not the serosa was finally penetrated. In others are included only the cases of rupture into the free abdominal cavity. As various degrees of ulcération may occur and as microscopic sections would be necessary to enable one to determine the exact extent of involvement in some instances, it has seemed logical to classify as cases of perforation only those in which the lesion actually perforated the entire wall, including the serosa. However, all such cases even though the perforation was walled off and not associated with general peritonitis, are included.The original purpose of limiting the study to newborn infants has not been adhered to slavishly. Only newborn patients are listed in the

Discharge outcomes of extremely low birth weight infants with spontaneous intestinal perforations

“…1 It lists the necropsy findings of three stillborn infants with isolated perforations proximal to the ileo-cecal valve. In the late 1950s, sporadic reports resurfaced of premature infants with SIPs without any evidence of intestinal obstruction.…”

Focal intestinal perforation in late preterm and term neonates with hypoxic ischemic encephalopathy

“…Many similar cases were subsequently reported in the literature, including Thelander's review of 83 cases of spontaneous gastrointestinal perforation (excluding known bowel obstruction) published between 1825 and 1939 [12]. In this series, which may have included newborns with necrotizing enterocolitis (NEC), most of the infants were born at term (90.4%; 75 of 83) and mortality was very high (98.8%; 82 of 83 died).…”

Recurrent Gastric Perforation in a Neonate Recovered after Primary Surgical Repair and Percutaneous Peritoneal Drainage

“…9 The first successful surgical repair was reported by Kellogg et al in 1951. 8 Three mechanisms have been proposed for sto mach perforation: traumatic, ischemic, and sponta neous.…”

“…Because of the rapid progress of gastric perforation, early diagnosis and treatment are very important. 9 Primary surgical repair is the most im portant treatment in gastric perforation. Mortality and morbidity increases as the time to begin the surgery delays.…”

“…8 Several subsequent reports of successful repair have been published, and improved survival rates have been documented. 7,9 An improvement of gastric perforation in neonates after percutaneous peritoneal drainage has not been described as much previously. …”