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Recurrent neonatal gastro-intestinal problems after spontaneous intestinal perforation

Presented at the Neonatal Society 2007 Summer Meeting (programme).

Drewett MS, Burge DM

Neonatal Surgical Service, Department of Neonatal Medicine and Surgery Princess Anne Hospital, Coxford Road, Southampton SO16 5YA, UK

Objective: Spontaneous isolated intestinal perforation (SIP) in the neonate in the absence of other macroscopic pathology such as NEC is well described (1, 2, 3) and appears to be becoming more common (4). Our recent experience with a number of patients who developed further intestinal problems after SIP, something not highlighted in previous reports, led to this review aimed to identify intestinal complications during the neonatal period following spontaneous isolated intestinal perforation (SIP).

Methods: 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 or suspected, but not confirmed, SIP. The study was undertaken in accordance with UK ethical guidelines.

Results: Seventeen patients, median gestation 27 weeks and median birth weight 780g, were treated by drain alone (1 case), drain and later laparotomy (4 cases) or primary laparotomy (12 cases). Eight patients required enterostomy formation at primary laparotomy (1 jejunostomy, 1 colostomy and 6 ileostomy). Five babies died in the neonatal period and 3 later in the first year (mortality 47%). Only 3 of the 8 deaths were directly related to intestinal complications. Nine patients (53%) had 10 subsequent episodes of intestinal pathology requiring surgical intervention between 5 and 136 days later comprising early recurrent isolated perforation (2 cases), necrotising enterocolitis (NEC) (3 cases), milk curd obstruction with or without perforation (3 cases) and adhesion obstruction (2 cases). Secondary surgery involved laparotomy in 8 patients, 5 of whom required formation or re-formation of a stoma, and palliative drain insertion in 1 patient.

Conclusions: 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.

1. Buchheit JQ, Stewart DL Pediatr; 1994; 93:32-36.
2. Pumberger W, Mayr M, Kohlhauser C et al . J Am Coll Surg 2002; 195(6):796-803.
3. Uceda JE, Laos CA, Kolni HW et al . J Pediatr Surg 1995; 30(9):1314-1316.
4. Hutson JM. Pediatr Surg Int 2004; 20(2):75-76.

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