Idiopathic gastrointestinal perforation in the neonate

To identify intestinal complications during the neonatal period following spontaneous isolated intestinal perforation (SIP). A retrospective case notes review was undertaken of all patients with a diagnosis of SIP, confirmed at laparotomy or post-mortem, admitted between January 2000 and January 2005. Patients with confirmed gastric perforation were excluded as were patients with proven necrotising enterocolitis (NEC) or suspected, but not confirmed, SIP. Seventeen patients, median gestation 27 weeks and median birth weight 780 g, were treated by drain alone (1), drain and later laparotomy (4) or primary laparotomy (12). Eight patients required enterostomy formation at primary laparotomy (1 jejunostomy, 1 colostomy and 6 ileostomy). Five babies died in the neonatal period and three later in the first year. Nine patients (53%) had ten subsequent episodes of intestinal pathology requiring surgical intervention between 5 and 136 days later comprising early recurrent isolated perforation (2), NEC (3), milk curd obstruction with or without perforation (3) and adhesion obstruction (2). Secondary surgery involved laparotomy in eight patients, five of whom required formation or re-formation of a stoma, and palliative drain insertion in one patient. Recurrent intestinal pathology requiring surgical intervention during the neonatal period occurred in 53% of babies with SIP. Surgeons and neonatologists should be aware that this group of patients are prone to further intestinal pathology.

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“…SIP has been well reported, since the 1980s [11,17,18]. It most commonly occurs in VLBW babies and seems to be distinct from NEC [14].…”

Section: Discussionmentioning

confidence: 98%

Recurrent neonatal gastro-intestinal problems after spontaneous intestinal perforation

Drewett

Burge

2007

Pediatr Surg Int

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“…Recently, idiopathic perforation has often been reported as an entity of localized intestinal perforations unrelated to NEC [17][18][19]. Localized perforation in GI tracts, including the colon, was also characterized by a favorable outcome as compared with NEC, although it may sometimes be difficult to distinguish between these two conditions [15][16][17][18][19]. Localized perforation was often associated with low-or very lowbirth-weight infants [15][16][17]19,20].…”

Section: Discussionmentioning

confidence: 99%

Perforation of the colon in neonates

Komuro

Urita

Hori

et al. 2005

Journal of Pediatric Surgery

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“…Asphyxia has been recognized as a risk factor for FIP [6]. Lloyd reported that birth asphyxia was present in 80% of the cases of his analysis of 83 neonates with gastrointestinal perforation, 50 of whom died (43 had autopsies performed) [16].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…In preterm neonates, these gastrointestinal perforations typically occur in extremely low birth weight (ELBW) infants, and appear to be associated with specific risk factors such as chorioamnionitis and exposure to postnatal steroids with or without indomethacin treatment [3e5]. In term neonates, although not as common, gastrointestinal perforations have been associated with birth asphyxia [6,7].Since perforations in neonates are usually associated with specific risk factors it may be preferable to describe the bowel injury as a "focal" intestinal perforation (FIP) [8,9], which alludes to the extent of injury rather than "spontaneous" intestinal perforation, which suggests that these risk factors are only coincidental. Histopathologically, FIP is characterized by focal intestinal perforations with necrosis of the muscularis externa and no ischemic damage [10].…”

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confidence: 99%

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Focal intestinal perforation in late preterm and term neonates with hypoxic ischemic encephalopathy

McAdams

Ledbetter

2015

Journal of Pediatric Surgery Case Reports

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a b s t r a c tFocal intestinal perforation (FIP) is a significant cause of morbidity and mortality in extremely low birth weight neonates. In late preterm or term neonates, birth asphyxia is a risk factor for FIP, although recent reports of FIP in these patients are limited. We describe two cases of FIP, one in a late preterm neonate and one in a term neonate, both associated with hypoxic ischemic encephalopathy. Potential risk factors and pathophysiological mechanisms of FIP in late preterm and term neonates are discussed. Ó 2015 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Gastrointestinal perforations without an identifiable cause, commonly referred to as idiopathic-, localized-, spontaneous, or focal intestinal perforations can occur in neonates, children, and adults [1,2]. In preterm neonates, these gastrointestinal perforations typically occur in extremely low birth weight (ELBW) infants, and appear to be associated with specific risk factors such as chorioamnionitis and exposure to postnatal steroids with or without indomethacin treatment [3e5]. In term neonates, although not as common, gastrointestinal perforations have been associated with birth asphyxia [6,7].Since perforations in neonates are usually associated with specific risk factors it may be preferable to describe the bowel injury as a "focal" intestinal perforation (FIP) [8,9], which alludes to the extent of injury rather than "spontaneous" intestinal perforation, which suggests that these risk factors are only coincidental. Histopathologically, FIP is characterized by focal intestinal perforations with necrosis of the muscularis externa and no ischemic damage [10]. Most of the recent literature on FIP discusses cases in ELBW neonates and reports of late preterm or term neonates with FIP are uncommon. We describe two cases of FIP, one in a late preterm neonate and one in a term neonate, both associated with hypoxic ischemic encephalopathy (HIE).

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Idiopathic gastrointestinal perforation in the neonate

Cited by 44 publications

References 14 publications

Recurrent neonatal gastro-intestinal problems after spontaneous intestinal perforation

Recurrent neonatal gastro-intestinal problems after spontaneous intestinal perforation

Perforation of the colon in neonates

Focal intestinal perforation in late preterm and term neonates with hypoxic ischemic encephalopathy

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