Percutaneous Pigtail Catheter Drainage of Spontaneous Intestinal Perforation in Premature Infants

Peritoneal drainage is an established management strategy for spontaneous intestinal perforation (SIP) in premature infants. We sought to evaluate the safety and efficacy of percutaneous pigtail catheter placement as an alternative to drain insertion via a lower quadrant incision.

Patients less than 32 weeks gestational age who underwent peritoneal drain placement for SIP at two neonatal intensive care units between 2011 and 2022 were identified. Incisional drainage (ID) or percutaneous pigtail catheter drainage (PD) was used based upon the usual practices of the surgeons. ID (n = 19) was performed via a 5-mm right lower quadrant incision into which a one-fourth-inch Penrose or red rubber catheter was placed. PD (n = 18) was accomplished using a Seldinger technique by which a 6.0 or 8.5 F pigtail catheter was passed through the left lower quadrant. Demographics and physiological parameters at the time of drainage were recorded and short-term and long-term outcomes were evaluated.

Thirty seven infants were identified. There were no differences in demographics or physiological derangement between the groups. Patients who underwent ID had more frequent stool drainage, a greater transfusion requirement, and a longer time to full feedings (60.6 v 37.7 d, P = 0.04). Incisional hernias (n = 3, 16%) only developed after ID. The duration of drain placement, length of stay, and time to resolution of pneumoperitoneum were similar with ID and PD as was the incidence of premature drain dislodgement and subsequent laparotomy.

Percutaneous drain placement provided effective drainage in infants with SIP and was associated with more rapid feeding advancement and no incidence of incisional hernia.