Comparative Study between Isolated Intestinal Perforation and Necrotizing Enterocolitis

Abstract

Comparing the groups, we found statistical significant differences in isolated perforation cases with these risk factors: extreme prematurity, very low birth weight, abruptio placenta, intubation and neonatal mechanical ventilation, umbilical catheterization, precocious sepsis, and indomethacin therapy. A more precocious operation and a good prognosis also reached statistical significance. In the other hand, we found statistically significant differences in NEC with congenital cardiopathy (excluding isolated patent ductus arteriosus), with intestinal pneumatosis, with diffuse bowel involvement and a worse prognosis. Risk factors and pathologic findings seem to support an ischaemic pathogenesis in both diseases.

T-tube ileostomy for intestinal perforation in extremely low birth weight neonates

“…The latter type of perforation is less well defined and appears in the literature under different names: spontaneous intestinal perforation, idiopathic intestinal perforation, focal intestinal perforation, or focal NEC [1,3,7,9,10]. Besides ischemic pathogenesis [10], the hypoperistalsis of immature bowel (ileus of prematurity) seems to be the main pathogenetic factor of perforation in ELBW neonates [7,11].…”

Prenatal or postnatal indomethacin exposure and neonatal gut injury associated with isolated intestinal perforation and necrotizing enterocolitis

“…16,38 Discontinuity or defects in the intestinal muscular layer and alteration in intestinal mucosal and muscular morphology by glucocorticoids (dexamethasone) have also been implicated as contributing factors to IIP. [45][46][47][48] The association between early postnatal indomethacin exposure and IIP may also have to do with the timing of exposure. One group of investigators reported negative end-diastolic flow velocity in one infant and absent end-diastolic flow velocity in seven preterm infants on day one of life.…”

Six-year retrospective analysis of colonic perforation in neonates and infants: Single centre experience

“…[15] Localised or idiopathic perforation accounts for one-third of all CP, but we found it in only 9 (15%) of patients. [15] The probable explanation is that our sample population included only full term neonate and infants, while idiopathic perforation occure mostly in low birth-weight babies.…”

“…[13,14] Localised or idiopathic perforation was described by Breslau in 1863 as "the perforation for which no other cause or NEC is found." [15] Usually, it occurs in low or very low birth-weight infants in whom traumatic delivery, congenital defects of the bowel with diverticulum formation, localised vascular insufficiency and intrauterine or post-partum infection have occurred. [15] Localised or idiopathic perforation accounts for one-third of all CP, but we found it in only 9 (15%) of patients.…”

“…[15] Usually, it occurs in low or very low birth-weight infants in whom traumatic delivery, congenital defects of the bowel with diverticulum formation, localised vascular insufficiency and intrauterine or post-partum infection have occurred. [15] Localised or idiopathic perforation accounts for one-third of all CP, but we found it in only 9 (15%) of patients. [15] The probable explanation is that our sample population included only full term neonate and infants, while idiopathic perforation occure mostly in low birth-weight babies.…”