PERFORATIVE PERITONITIS IN NEWBORNS: INSTRUMENTAL AND MORPHOLOGICAL EXAMINATION FINDINGS

The aim: To study and analyze the results of instrumental diagnostic measures and morphological verification of perforations of abdominal viscera in peritonitis in newborns, their importance in timely diagnosis, as well as to present authors' experience of examining newborns with PP, taking into account the complexity of diagnosis and treatment of these patients.

Materials and methods: The study is based on the results of examining 59 newborns with PP of various etiologies. Instrumental methods that were used in the diagnosis of PP and differential diagnosis of other emergencies involved the following: radiological examination (plain abdominal radiography), abdominal and retroperitoneal ultrasound, neurosonography, echocardiography, diagnostic abdominal paracentesis. Morphological verification of hollow viscus perforations was performed by methods of histologic examination in 54 newborns who underwent surgery.

Results: It is emphasized that perforations in NEC and spontaneous gastrointestinal perforations have clinical and morphological differences. The analysis of morphological data showed absence of intestinal musculature or muscular wall defect in spontaneous gastrointestinal perforations. Perforations in NEC had massive gastric or bowel wall necrosis. Morphogenesis of gastrointestinal perforations in newborns is crucial for developing correct treatment strategy and choosing surgical approach.

Conclusions: Diagnosis of PP in newborns should be comprehensive and include modern instrumental studies that enable to reliably establish the cause of peritonitis and indications for surgical treatment. Differential diagnosis of PP in newborns with other diseases aims to differentiate PP from a number of similar clinical symptoms of urgent conditions in order to conduct adequate preoperative preparation and appropriate surgery. Diagnostic markers of PP involve the following: pneumoperitoneum, free fluid in the abdomen, sentinel loop (intestinal distention), fixed bowel loop, cloudy brown or greenish intra-abdominal fluid with a large number of leukocytes and bacteria.