Long term outcome of preterm infants with isolated intestinal perforation: A comparison between primary anastomosis and ileostomy
Related Experiment Video
Updated: Mar 22, 2026
Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Irene de Haro Jorge1, Jordi Prat Ortells1, Asteria Albert Cazalla1
1Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona; Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona.
Insights
For preterm infants with isolated intestinal perforation (IIP), ileostomy is a safer treatment than primary anastomosis. Primary anastomosis led to significantly higher rates of mortality and major complications in this vulnerable population.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Gastrointestinal Surgery
Background:
- Isolated intestinal perforation (IIP) in neonates presents a surgical challenge.
- Primary anastomosis and ileostomy are surgical options for IIP.
- Limited comparative data exists for these treatment approaches in preterm infants.
Purpose of the Study:
- To compare outcomes of primary anastomosis versus ileostomy for isolated intestinal perforation in preterm infants.
- To evaluate the safety and efficacy of two surgical management strategies for IIP.
Main Methods:
- Retrospective review of preterm infants undergoing laparotomy for IIP (2000-2013).
- Exclusion of neonates with extensive necrotizing enterocolitis or comorbidities.
- Comparison of major complications, including reoperation, late NEC, and mortality between ileostomy and primary anastomosis groups.
Main Results:
- 14 patients received primary anastomosis (PA) and 9 received ileostomy (I).
- Mortality was significantly higher in the PA group (50% vs. 0%, p=0.019).
- Major complications (71% vs. 11%, p=0.029) and late NEC (all in PA group, p=0.048) were more frequent with PA.
Conclusions:
- Primary anastomosis in preterm neonates with IIP is associated with increased risk of severe complications.
- Ileostomy appears to be a safer management strategy for isolated intestinal perforation in this high-risk infant population.
Aim Of The Study:
Management of isolated intestinal perforation (IIP) poses a challenge for the pediatric surgeon. Intestinal resection and primary anastomosis is considered to be as good as the classical approach, namely, intestinal diversion by ileostomy. However, few reports compare primary anastomosis and ileostomy as IIP treatment. In our institution we favored primary anastomosis as first line treatment whenever patient's condition permitted. Our purpose is to retrospectively compare the outcomes of preterm infants treated with primary anastomosis or ileostomy during a laparotomy in which an IIP was found.
Method:
We identified all newborns who had abdominal operations for IIP from 2000 through 2013. Patients with extensive necrotizing entorocolitis and comorbidities were excluded, as well as those who died in the first 24h. Demographics, type of treatment and complications were reviewed. Major complications included the need for an urgent reoperation, development of late NEC and death.
Results:
Twenty-three patients with a median gestational age (GA) of 27weeks and median birth weight (BW) of 883g had receive two types of treatment: group I included 9 patients who had intestinal resection of the affected bowel and ileostomy; group PA consisted of 14 patients who had intestinal resection and primary anastomosis. The decision to perform PA or I was based on the surgeon's judgment, in the absence of a specific protocol. There were no significant differences in GA and BW between both groups. Overall mortality was 30.4%. However mortality was restricted to group PA (n=7 cases; 50%) (p=0.019). Most major complications occurred in group PA (71% vs. 11%, p=0.029). There were six cases of late NEC, all in group PA (p=0.048), and four of those patients died. Other than the type of treatment, no differences could be identified between both groups.
Conclusion:
Preterm newborns with IIP are at a higher risk for developing life-threatening complications if treated with primary anastomosis than with ileostomy.
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