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Spontaneous bowel perforation in infants and young children: a clinicopathologic analysis of pathogenesis
J C Chen1, C C Chen, J T Liang
1Department of Surgery, Chang Gung Children's Hospital, Chang-Gung University College of Medicine, Taipei, Taiwan.
Insights
Severe dehydration from acute diarrhea can cause spontaneous bowel perforation in children. This rare condition requires prompt medical attention to prevent serious complications and fatalities.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Pathology
Background:
- Spontaneous bowel perforation without a clear cause is a rare but serious condition in children beyond the neonatal period.
- This condition often goes unrecognized, leading to delayed treatment and poorer outcomes.
- A clinicopathologic analysis was conducted to understand the underlying causes of this specific type of bowel perforation.
Purpose of the Study:
- To investigate the clinicopathologic features of spontaneous bowel perforation in children.
- To identify potential pathogenetic mechanisms contributing to this rare abdominal catastrophe.
Main Methods:
- A retrospective analysis of 15 previously healthy children with spontaneous bowel perforation was performed between 1984 and 1997.
- Children with known causes of perforation were excluded.
- Clinical data, surgical findings, pathological evaluations, and patient outcomes were analyzed.
Main Results:
- All patients presented with high fever, acute watery diarrhea, and clinical dehydration, followed by abdominal distension and perforation 5-30 days later.
- Perforations occurred in specific watershed areas: splenic flexure (7), lower sigmoid (3), and ileocecal region (5).
- Histopathology revealed acute suppurative inflammation and coagulation necrosis of the muscularis propria in most cases. One death and three major sequelae were reported.
Conclusions:
- Severe dehydration associated with acute diarrheal diseases can lead to bowel ischemia and subsequent perforation in children.
- Physicians must maintain a high index of suspicion for this condition in children presenting with progressive abdominal distension after acute diarrhea episodes.
Background:
In children beyond the neonatal stage, spontaneous bowel perforation with no specific cause is rare. It has attracted little notice and does not fit into any established clinical category. This often results in treatment delays. To determine the underlying pathogenesis, a clinicopathologic analysis of this group of patients was performed.
Methods:
From 1984 through 1997, 15 previously healthy children (10 boys and 5 girls) with bowel perforations were enrolled in this study. Children in whom the specific cause was established were excluded. The ages of the patients ranged from 3 months to 5 years, 5 months (average age: 2 years, 4 months). Data on clinical course, surgical and pathologic findings, and outcomes were analyzed.
Results:
All the patients had high fever and acute, watery diarrhea with clinical dehydration. Abdominal distension developed and bowel perforation ensued 5 to 30 days after the onset of diarrhea. In all cases, the perforation consisted of either an isolated patch of bowel (n = 8) or patchy lesions in a segment (n = 7), which was confined to one of the following three anatomic watershed areas: the splenic flexure (n = 7); the lower sigmoid (n = 3); and the ileocecal region (n = 5). One patient died, and three had major sequelae including intra-abdominal abscess, adhesion ileus, and peristomal fistula. Specimens from 13 patients were submitted for histopathologic evaluation. All specimens had acute suppurative inflammation diffusely around the perforation site. Seven had areas of coagulation necrosis of the muscularis propria, especially in the inner circular muscle layer.
Conclusion:
In acute diarrheal diseases, dehydration may cause bowel ischemia and lead to perforation. Physicians should be alert to the possibility of this abdominal catastrophe when progressive abdominal distension followed by acute diarrheal episodes occurs in children.