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Radiographic diagnosis of intestinal perforation in early infancy
Insights
Infant intestinal perforation is a serious condition with high mortality, especially when pneumoperitoneum is present. Early diagnosis using roentgen features is crucial for timely treatment and improved outcomes in neonates.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Diagnostic Imaging
Background:
- Intestinal perforation in early infancy is a critical surgical emergency.
- Associated factors include prematurity, congenital anomalies, and iatrogenic complications.
- Accurate diagnosis is essential for effective management and survival.
Purpose of the Study:
- To review cases of intestinal perforation in neonates treated over 15 years.
- To analyze the impact of pneumoperitoneum on mortality rates.
- To evaluate the role of roentgenographic findings in diagnosis and treatment.
Main Methods:
- Retrospective review of 25 patient records with intestinal perforation.
- Categorization based on the presence or absence of roentgen evidence of pneumoperitoneum.
- Analysis of mortality rates, causative factors, and diagnostic utility of imaging.
Main Results:
- Overall mortality rate was 88% across 25 infant cases.
- Mortality was significantly higher (94%) in infants with pneumoperitoneum compared to those without (78%).
- Diverse gastrointestinal sites were affected; causes were often unclear.
Conclusions:
- Intestinal perforation in infancy carries a grave prognosis, particularly with pneumoperitoneum.
- Associated factors like prematurity and congenital anomalies are common.
- Roentgenographic features are vital for prompt diagnosis and guiding appropriate surgical intervention.
Abstract:
Records of 25 patients with intestinal perforation in early infancy who were treated at the Los Angeles County General Hospital in a period of 15 years were reviewed. Sixteen had roentgen evidence of pneumoperitoneum, and nine did not. The mortality rate was 94 per cent in the group with pneumoperitoneum, 78 per cent in the other, and 88 per cent overall. Multiple sites in the gastrointestinal tract were involved, and the causes of the lesions were diverse and frequently obscure. Prematurity, obstetrical and iatrogenic complications, and congenital anomalies were factors often associated with intestinal perforation. Roentgen features appeared to offer the best hope for diagnosis and appropriate treatment.