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Spontaneous Intestinal Perforation: The Long-Term Outcome
Christoph Heinrich Houben1, Xiang-Nan Feng2, Kin Wai Edwin Chan3
1Department of Surgery, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
Insights
Spontaneous intestinal perforation (SIP) in extremely low birth weight (ELBW) infants often occurs with intraventricular hemorrhage (IVH). Long-term outcomes show significant neurological disabilities, particularly in males, with low surgical complication risks.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Neonatal intensive care
Background:
- Spontaneous intestinal perforation (SIP) is a critical surgical emergency in neonates.
- Extremely low birth weight (ELBW) infants are particularly vulnerable to SIP.
- Understanding long-term outcomes is crucial for improving patient management.
Purpose of the Study:
- To evaluate the long-term outcomes of infants treated for spontaneous intestinal perforation (SIP).
- To identify risk factors and common sites of perforation in SIP.
- To assess the incidence of associated conditions like intraventricular hemorrhage (IVH) and long-term disabilities.
Main Methods:
- Retrospective study of all patients treated for SIP between 2005 and 2014.
- Analysis of patient demographics, gestational age, birth weight, and co-morbidities.
- Long-term follow-up to assess neurological development and surgical complications.
Main Results:
- The cohort included 23 infants, predominantly ELBW (74%) with a median gestational age of 26 weeks.
- Patent ductus arteriosus (PDA) was common (70%), and 44% developed intraventricular hemorrhage (IVH), often preceding perforation.
- Ileal perforation (88%) was most frequent; 8.7% of male infants died, and 26% developed moderate to severe disabilities, including cerebral palsy.
Conclusions:
- ELBW is the primary risk factor for SIP.
- IVH is a frequent comorbidity, often occurring before perforation.
- Significant long-term neurological disabilities affect over a quarter of survivors, with males disproportionately affected. Surgical risks are minimal.
Abstract:
Background/Purpose Evaluating the long-term outcome of spontaneous intestinal perforation (SIP). Methods We studied all patients treated for SIP at our institution between January 1, 2005 and December 31, 2014. Results Twenty-three infants (13 males) with a median gestational age of 26 (range: 23-32) weeks and a median weight of 825 (range: 560-1,965) g composed this cohort. Seventeen (74%) infants had an extremely low birth weight (ELBW); nine (39%) infants were the result of multiple pregnancies.Patent ductus arteriosus (PDA) was present in 16 (70%) infants. Cyclooxygenase inhibitors were administered in 12 (52%) infants.Ten infants (seven males, 44%) were diagnosed with intraventricular hemorrhage (IVH), which was identified in the majority (8/10) at a median of 9 (range: 1-11) days prior to the perforation.All patients presented with pneumoperitoneum and underwent a laparotomy at a median age of 9 (range: 2-16) days. Twenty-one patients had an ileal perforation. A temporary stoma was placed in 21 patients, whereas two got primary anastomosis. Two (8.7%) male infants died. During the long-term follow-up period (median 6 years), six (five males) (26%) infants developed moderate to severe disabilities in combination with cerebral palsy. No surgical complications were observed. Conclusion The most important risk factor for SIP is ELBW (75%). The distal ileum is the most frequent site of perforation (88%). Approximately 40% develop IVH most often prior to the SIP. Moderate to severe neurologic disabilities are seen in more than a quarter of the children. Disability and mortality affect mostly the male sex. Long-term risks of surgical complications are very low.
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