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Identifying Preoperative Clinical Characteristics of Unexpected Gastrointestinal Perforation in Infants-A
Adinda G H Pijpers1,2,3, Ramon R Gorter1, Laurens D Eeftinck Schattenkerk1
1Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Insights
Infants with unexpected gastrointestinal perforation (GIP) are at higher risk for small bowel perforation if they are premature or have low birth weight. Colon perforations warrant screening for Hirschsprung disease and cystic fibrosis.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Gastroenterology
Background:
- Unexpected pneumoperitoneum in infants signifies gastrointestinal perforation (GIP), a critical surgical emergency.
- Preoperative localization of GIP is challenging, impacting surgical strategy due to differences between small bowel and colon perforations.
Purpose of the Study:
- To characterize preoperative patient factors in infants with unexpected GIP.
- To differentiate between small bowel and colon perforations.
- To identify underlying causes of GIP in this cohort.
Main Methods:
- Retrospective analysis of infants (≤ 6 months) with unexpected pneumoperitoneum undergoing surgery (1996-2024).
- Statistical analysis (chi-squared, t-tests, Bonferroni correction) to compare perforation locations.
- Review of preoperative characteristics and final diagnoses.
Main Results:
- 51 infants presented with unexpected GIP; 26 small bowel, 22 colon, 3 stomach perforations.
- Small bowel perforations were associated with prematurity, low birth weight (<1000g), respiratory support, and lower arterial pH.
- Colon perforations showed higher incidence of pneumatosis intestinalis and were linked to Hirschsprung disease and cystic fibrosis.
Conclusions:
- Prematurity and low birth weight (<1000g) increase the risk of small bowel perforation in infants with GIP.
- Colon perforations necessitate further investigation for Hirschsprung disease and cystic fibrosis.
Background:
Infants presenting with unexpected pneumoperitoneum upon abdominal X-ray, indicating a gastrointestinal perforation (GIP), have a surgical emergency with potential morbidity and mortality. Preoperative determination of the location of perforation is challenging but will aid the surgeon in optimizing the surgical strategy, as colon perforations are more challenging than small bowel perforations. Therefore, the aim of this study is to provide an overview of preoperative patient characteristics, determine the differences between the small bowel and colon, and determine underlying causes in a cohort of infants with unexpected GIP.
Methods:
All infants (age ≤ 6 months) who presented at our center with unexpected pneumoperitoneum (no signs of pneumatosis before) undergoing surgery between 1996 and 2024 were retrospectively included. The differences between the location of perforation were analyzed using chi-squared and t-tests. Bonferroni correction was used to adjust for multiple tests.
Results:
In total, 51 infants presented with unexpected pneumoperitoneum at our center, predominantly male (N = 36/51) and premature (N = 40/51). Among them, twenty-six had small bowel, twenty-two colon, and three stomach perforations. Prematurity (p = 0.001), birthweight < 1000 g (p = 0.001), respiratory support (p = 0.001), and lower median arterial pH levels (p = 0.001) were more present in patients with small bowel perforation compared with colon perforations. Pneumatosis intestinalis was more present in patients with colon perforation (p = 0.004). All patients with Hirschsprung disease and cystic fibrosis had colon perforation. The final diagnoses were mainly focal intestinal perforations (N = 27/51) and necrotizing enterocolitis (N = 9/51).
Conclusions:
Infants with unexpected GIP, birthweight < 1000 g, and prematurity have more risk for small bowel perforation. In case of colon perforation, additional screening (for Hirschsprung and cystic fibrosis) should be considered.
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