Recurrent neonatal gastro-intestinal problems after spontaneous intestinal perforation

Abstract

To identify intestinal complications during the neonatal period following spontaneous isolated intestinal perforation (SIP). A retrospective case notes review was undertaken of all patients with a diagnosis of SIP, confirmed at laparotomy or post-mortem, admitted between January 2000 and January 2005. Patients with confirmed gastric perforation were excluded as were patients with proven necrotising enterocolitis (NEC) or suspected, but not confirmed, SIP. Seventeen patients, median gestation 27 weeks and median birth weight 780 g, were treated by drain alone (1), drain and later laparotomy (4) or primary laparotomy (12). Eight patients required enterostomy formation at primary laparotomy (1 jejunostomy, 1 colostomy and 6 ileostomy). Five babies died in the neonatal period and three later in the first year. Nine patients (53%) had ten subsequent episodes of intestinal pathology requiring surgical intervention between 5 and 136 days later comprising early recurrent isolated perforation (2), NEC (3), milk curd obstruction with or without perforation (3) and adhesion obstruction (2). Secondary surgery involved laparotomy in eight patients, five of whom required formation or re-formation of a stoma, and palliative drain insertion in one patient. Recurrent intestinal pathology requiring surgical intervention during the neonatal period occurred in 53% of babies with SIP. Surgeons and neonatologists should be aware that this group of patients are prone to further intestinal pathology.

Milk curd obstruction in premature infants receiving fortified expressed breast milk

“…Abdominal pathology is unlikely to increase the susceptibility for milk curd obstruction as such, but it may increase the susceptibility for further abdominal pathology. This would correspond with the findings in a recent report of babies with isolated intestinal perforation: nine of 17 developed further intestinal pathology including three with milk curd obstruction 6 …”

“…Since then, this condition has been reported under different names, including milk bolus obstruction and milk fat bolus obstruction. However, as the term ‘milk curd obstruction’ remains the most frequently and most recently used, 5,6 we continue to use this term in this report.…”

Emergency laparotomy in infants born at <26 weeks gestation: a neonatal network-based cohort study of frequency, surgical pathology and outcomes

“…This was either emergency laparotomy for further acute intestinal pathology or stoma closure. We have previously highlighted a high incidence of further intestinal pathology following laparotomy for SIP,22 which accounted for the majority of these cases.…”

Advanced Necrotizing Enterocolitis Part 2: Recurrence of Necrotizing Enterocolitis

“…NEC is a devastating disease of the neonatal period, often necessitating surgical intervention with long-term morbidity and mortality. [9][10][11][12] Infants who survive the acute NEC episode Figure 1 Flow chart of infants with NEC.…”