Korean J Pediatr.  2015 Aug;58(8):288-293. 10.3345/kjp.2015.58.8.288.

Comparison of gastric and other bowel perforations in preterm infants: a review of 20 years' experience in a single institution

• Lee DK
• Shim SY
• Cho SJ
• Park EA
• Lee SW

• KMID: 2284603
• DOI: http://doi.org/10.3345/kjp.2015.58.8.288

Abstract

PURPOSE
In this study, we aimed to review the clinical presentation of preterm infants with gastrointestinal perforations and compare the clinical features of gastric perforation with other intestinal perforations.
METHODS
The medical records of preterm neonates with pneumoperitoneum, admitted to the neonatal intensive care unit (NICU) between January 1994 and December 2013, were retrospectively reviewed.
RESULTS
Twenty-one preterm infants underwent exploratory laparotomy to investigate the cause of the pneumoperitoneum. The sample consisted of five patients (23.8%) with gastric perforation and 16 patients (76.2%) with intestinal perforation. No statistical differences were found in the birth history and other perinatal factors between the two groups. Underlying necrotizing enterocolitis, bilious vomiting, and paralytic ileus preceding the perforation were statistically more common in the intestinal perforation group. All preterm infants with gastric perforation survived to discharge; however, six preterm infants with intestinal perforation expired during treatment in the NICU. In the gastric perforation group, sudden pneumoperitoneum was the most common finding, and the mean age at diagnosis was 4.4+/-1.7 days of life. The location and size of the perforations varied, and simple closure or partial gastrectomy was performed.
CONCLUSION
Patients with gastric perforation did not have a common clinical finding preceding the perforation diagnosis. Although mortality in previous studies was high, all patients survived to discharge in the present study. When a preterm infant aged less than one week presents with sudden abdominal distension and pneumoperitoneum, gastric perforation should first be excluded. Prompt exploratory laparotomy will increase the survival rates of these infants.

Keyword

Pneumoperitoneum; Stomach rupture; Infant; Premature

MeSH Terms

Diagnosis
Enterocolitis, Necrotizing
Gastrectomy
Humans
Infant
Infant, Newborn
Infant, Premature*
Intensive Care, Neonatal
Intestinal Perforation
Intestinal Pseudo-Obstruction
Laparotomy
Medical Records
Mortality
Pneumoperitoneum
Reproductive History
Retrospective Studies
Stomach Rupture
Survival Rate
Vomiting