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Comparative study between isolated intestinal perforation and necrotizing enterocolitis.

X Tarrado1, M Castañón, M Thió

  • 1Servei de Cirurgia Pediàtrica, Unitat Integrada, Hospital Sant Joan de Déu/Hospital Clínic, Barcelona, Universitat de Barcelona, Spain. xtarrado@hsjdbcn.org

European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [Et Al] = Zeitschrift Fur Kinderchirurgie
|May 7, 2005
PubMed
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Neonatal intestinal perforation can be isolated (IP) or due to necrotizing enterocolitis (NEC). Isolated perforation is linked to extreme prematurity and specific medical interventions, while NEC involves different risk factors and has a worse prognosis.

Area of Science:

  • Neonatalogy
  • Pediatric Surgery
  • Gastroenterology

Background:

  • Neonatal intestinal perforations are commonly associated with necrotizing enterocolitis (NEC) or intestinal occlusion.
  • Isolated perforation (IP) refers to intestinal perforation occurring without these conditions.
  • Pathogenic mechanisms for IP often overlap with those of NEC.

Purpose of the Study:

  • To identify and compare the clinical and pathological features of isolated perforation (IP) and necrotizing enterocolitis (NEC) in neonates.
  • To elucidate potential differences in risk factors, presentation, and outcomes between IP and NEC.

Main Methods:

  • A retrospective review of neonatal intestinal perforation and NEC cases over five years.
  • Classification of 33 patients into Group NEC (24 cases) and Group IP (9 cases).

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  • Collection of data on general features, obstetric history, neonatal treatment, comorbidity, perforation characteristics, treatment, and outcomes.

    • Main Results:

    • IP cases showed significant associations with extreme prematurity, very low birth weight, abruptio placenta, intubation, mechanical ventilation, umbilical catheterization, early sepsis, and indomethacin therapy.
    • IP cases also had a trend towards earlier surgical intervention and better prognosis compared to NEC.
    • NEC cases were more frequently associated with congenital cardiopathy, intestinal pneumatosis, diffuse bowel involvement, and a worse prognosis.

    Conclusions:

    • Risk factors and pathological findings suggest an ischemic pathogenesis may underlie both isolated perforation and necrotizing enterocolitis.
    • Distinct clinical features and outcomes differentiate IP from NEC, aiding in diagnosis and management.