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Perforation of the gastrointestinal tract in infancy and childhood
Insights
Infants and children with gastrointestinal tract perforations face high mortality. Early diagnosis via imaging and prompt transfer to pediatric intensive care units are crucial for improving outcomes in these critical cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Care
Background:
- Gastrointestinal tract perforations are a serious condition in infants and children.
- Appendicitis-related perforations were excluded from this study.
- A significant number of cases occurred in neonates (55 out of 88 patients).
Purpose of the Study:
- To analyze the causes, locations, and outcomes of gastrointestinal perforations in pediatric patients.
- To identify factors influencing mortality rates.
- To suggest strategies for reducing mortality.
Main Methods:
- Retrospective review of 88 pediatric patients with gastrointestinal perforations.
- Analysis of perforation locations, causes, age distribution, and treatment outcomes.
- Correlation of diagnostic methods and supportive care with mortality.
Main Results:
- The most frequent locations were the ileum and rectosigmoid.
- Necrotizing enterocolitis was the leading cause, followed by ulcers and unknown etiologies.
- The overall mortality rate was high at 55.7% (49 out of 88 patients).
- No significant reduction in mortality was observed over the last decade.
Conclusions:
- Early diagnosis, often aided by roentgenograms, is essential.
- Improved supportive care, rapid transfer to pediatric intensive care units, and broad-spectrum antimicrobial agents are recommended.
- Despite advances, mortality remains high, emphasizing the need for timely and effective interventions.
Abstract:
Eighty-eight patients with perforations of the gastrointestinal tract in infancy and childhood, excluding those caused by appendicitis, are presented. Fifty-five patients were four weeks of age or younger. Fourteen of the perforations occurred during the first year of life and 19 occurred between one and 15 years of age. The locations of perforations by order of frequency were the ileum, rectosigmoid, stomach and duodenum. The causes in order of frequency were necrotizing enterocolitis, ulcers, unknown causes, Hirschsprung's disease, atresia of the small intestine, volvulus, trauma, gastroschisis and ventriculoperitoneal shunts for hydrocephalus. A high index of suspicion, aided by roentgenograms, is essential for an early diagnosis. The over-all mortality was 49 of 88 patients. No reduction in mortality was observed in the last ten years, despite improved surgical techniques and better antimicrobial agents. Early recognition and rapid transport of the child to a pediatric intensive care unit with better supportive measures plus antimicrobial agents effective against both anaerobic and aerobis bacteria should reduce this high mortality.