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The role of peritoneal drainage for intestinal perforation in infants with and without necrotizing enterocolitis
J D Rovin1, B M Rodgers, R C Burns
1Department of Surgery, University of Virginia Health System, Charlottesville 22906-0011, USA.
Insights
Peritoneal drainage (PD) offers initial improvement for premature infants with intestinal perforation. While definitive for some without necrotizing enterocolitis (NEC), those with NEC often still require surgery but stabilize first.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Surgical critical care
Background:
- Intestinal perforation is a serious complication in premature infants.
- Necrotizing enterocolitis (NEC) is a common cause of intestinal perforation in this population.
- Peritoneal drainage (PD) is explored as an initial management strategy.
Purpose of the Study:
- To review the experience with peritoneal drainage (PD) as initial therapy for intestinal perforation in premature infants.
- To compare outcomes in infants with and without necrotizing enterocolitis (NEC).
Main Methods:
- Chart review of 18 premature infants undergoing PD for intestinal perforation (1995-1998).
- Group 1: 8 infants with perforation, no NEC.
- Group 2: 10 infants with perforation and NEC.
- Historical control: 10 infants treated with primary laparotomy (1990-1995).
Main Results:
- All infants showed immediate improvement with PD.
- In infants without NEC (Group 1), 88% recovered systemically, with 63% avoiding laparotomy.
- In infants with NEC (Group 2), 80% survived, but 88% ultimately required laparotomy, though PD allowed stabilization.
Conclusions:
- Peritoneal drainage (PD) provides acute improvement and systemic recovery in premature infants with intestinal perforation.
- PD may be definitive treatment for perforation without NEC.
- For perforation with NEC, PD facilitates initial stabilization, potentially preserving intestine before necessary laparotomy.
Background/Purpose:
This report reviews our experience using peritoneal drainage (PD) as initial therapy for intestinal perforation in premature infants with and without necrotizing enterocolitis (NEC).
Methods:
A chart review was conducted of 18 consecutive premature infants who underwent PD for intestinal perforation from 1995 to 1998. Infants were divided into two groups. Group 1 consisted of eight infants who had intestinal perforation without evidence of NEC. Group 2 consisted of 10 infants who had perforation associated with evidence of NEC. A cohort of 10 infants with intestinal perforation treated with primary laparotomy between 1990 and 1995 was identified by chart review for historical control.
Results:
All infants improved immediately after PD. In group 1, all survived. Seven (88%) recovered systemically after PD. Of these, five (63%) never required laparotomy. Two (25%) required delayed laparotomy. One infant (12%) failed to continue to improve 48 hours after PD and underwent urgent laparotomy and recovered. In group 2, eight (80%) infants survived. Six (60%) recovered from NEC after PD, but five required delayed laparotomy for obstruction or persistent drainage. Four infants (40%) failed to progress from their initial improvement after PD. Three underwent laparotomy; two recovered and one had total intestinal necrosis and died. The fourth infant died without exploration and total intestinal necrosis was discovered during autopsy. Thus, seven of eight survivors (88%) in group 2 required laparotomy at some point in their course.
Conclusions:
In premature infants with intestinal perforation, PD allows acute improvement and usually systemic recovery. In infants without evidence of NEC, PD may afford definitive treatment. In contrast, infants with evidence of NEC will likely require laparotomy, but initial PD may allow systemic stabilization and recovery of much of the involved intestine before laparotomy.