Pediatr Gastroenterol Hepatol Nutr.  2016 Sep;19(3):193-198. 10.5223/pghn.2016.19.3.193.

Spontaneous Perforation of Colon in Previously Healthy Infants and Children: Its Clinical Implication

• Kim SH
• Cho YH
• Kim HY

• KMID: 2364778
• DOI: http://doi.org/10.5223/pghn.2016.19.3.193

Abstract

PURPOSE
Spontaneous colon perforations are usually encountered as necrotizing enterocolitis in the neonatal period, but occur rarely in infants and children without pathological conditions. This study was conducted to describe its clinical implication beyond the neonatal period.
METHODS
Cases of spontaneous colon perforation confirmed after the operation were reviewed retrospectively and the clinicopathological characteristics were analyzed. Clinical data were compared according to the presence of pneumoperitoneum as initial findings.
RESULTS
Eleven patients were included in the study period and showed a history of hospitalization before transfer due to management for fever, respiratory or gastrointestinal problems. Six patients showed a sudden onset of abdominal distention and only seven patients showed a pneumoperitoneum as initial radiologic findings, however there were no significant clinicopathological differences. Perforation was found evenly in all segments of the colon, most commonly at the sigmoid colon in four cases. There were no specific pathologic or serologic causes of perforation.
CONCLUSION
When previously healthy infants and children manifest a sustained fever with a sudden onset of abdominal distention during management for fever associated with respiratory or gastrointestinal problems, there is a great likelihood of colon perforation with no pathological condition. Prompt surgical management as timely decision-making is necessary in order to achieve a good progress.

Keyword

Child; Colon; Infant; Spontaneous; Perforation

MeSH Terms

Child*
Colon*
Colon, Sigmoid
Enterocolitis, Necrotizing
Fever
Hospitalization
Humans
Infant*
Pneumoperitoneum
Retrospective Studies

Reference

1. Komuro H, Urita Y, Hori T, Hirai M, Kudou S, Gotoh C, et al. Perforation of the colon in neonates. J Pediatr Surg. 2005; 40:1916–1919.

2. Levine SE, Isaacson C. Spontaneous perforation of the colon in the newborn infant. Arch Dis Child. 1960; 35:378–382.

3. Georgy FM. Neonatal perforation of the colon. Am J Obstet Gynecol. 1975; 122:788–789.

4. Yang B, Ni HK. Diagnosis and treatment of spontaneous colonic perforation: analysis of 10 cases. World J Gastroenterol. 2008; 14:4569–4572.

5. Serpell JW, Nicholls RJ. Stercoral perforation of the colon. Br J Surg. 1990; 77:1325–1329.

6. Haddad R, Bursle G, Piper B. Stercoral perforation of the sigmoid colon. ANZ J Surg. 2005; 75:244–246.

7. Zamir O, Goldberg M, Udassin R, Peleg O, Nissan S, Eyal F. Idiopathic gastrointestinal perforation in the neonate. J Pediatr Surg. 1988; 23:335–337.

8. Weinberg G, Kleinhaus S, Boley SJ. Idiopathic intestinal perforations in the newborn: an increasingly common entity. J Pediatr Surg. 1989; 24:1007–1008.

9. Kasahara Y, Matsumoto H, Umemura H, Shirafa S, Kuyama T. Idiopathic perforation of the sigmoid colon in Japan. World J Surg. 1981; 5:125–130.

10. Chen JC, Chen CC, Liang JT, Huang SF. Spontaneous bowel perforation in infants and young children: a clinicopathologic analysis of pathogenesis. J Pediatr Gastroenterol Nutr. 2000; 30:432–435.

11. Byrne MF, McGuinness J, Smyth CM, Manning DS, Sheehan KM, Bohra SG, et al. Nonsteroidal anti-inflammatory drug-induced diaphragms and ulceration in the colon. Eur J Gastroenterol Hepatol. 2002; 14:1265–1269.

12. Langman MJ, Morgan L, Worrall A. Use of anti-inflammatory drugs by patients admitted with small or large bowel perforations and haemorrhage. Br Med J (Clin Res Ed). 1985; 290:347–349.

13. Schiffmann L, Kahrau S, Berger G, Buhr HJ. Colon perforation in an adolescent after short-term diclofenac intake. ANZ J Surg. 2005; 75:726–727.

14. Bjarnason I, Takeuchi K. Intestinal permeability in the pathogenesis of NSAID-induced enteropathy. J Gastroenterol. 2009; 44:Suppl 19. 23–29.

15. Davies NM. Toxicity of nonsteroidal anti-inflammatory drugs in the large intestine. Dis Colon Rectum. 1995; 38:1311–1321.

16. Grosfeld JL, Kamman K, Gross K, Cikrit D, Ross D, Wolfe M, et al. Comparative effects of indomethacin, prostaglandin E1, and ibuprofen on bowel ischemia. J Pediatr Surg. 1983; 18:738–742.

17. Gordon PV, Herman AC, Marcinkiewicz M, Gaston BM, Laubach VE, Aschner JL. A neonatal mouse model of intestinal perforation: investigating the harmful synergism between glucocorticoids and indomethacin. J Pediatr Gastroenterol Nutr. 2007; 45:509–519.

18. Chappuis CW, Frey DJ, Dietzen CD, Panetta TP, Buechter KJ, Cohn I Jr. Management of penetrating colon injuries. A prospective randomized trial. Ann Surg. 1991; 213:492–497. discussion 497-8.

19. Ivatury RR, Gaudino J, Nallathambi MN, Simon RJ, Kazigo ZJ, Stahl WM. Definitive treatment of colon injury: a prospective study. Am Surg. 1993; 59:43–49.

20. Schlinkert RT, Rasmussen TE. Laparoscopic repair of colonoscopic perforations of the colon. J Laparoendosc Surg. 1994; 4:51–54.

21. Mattei P, Alonso M, Justinich C. Laparoscopic repair of colon perforation after colonoscopy in children: report of 2 cases and review of the literature. J Pediatr Surg. 2005; 40:1651–1653.

22. Chang YJ, Yan DC, Kong MS, Chao HC, Huang CS, Lai JY. Non-traumatic colon perforation in children: a 10-year review. Pediatr Surg Int. 2006; 22:665–669.

23. Chiang LW, Lee SY. Laparoscopic management for non-traumatic colon perforation in children. Pediatr Surg Int. 2013; 29:353–356.

24. Siddharth P, Ravo B. Colorectal neurovascularture and anal sphincter. Surg Clin North Am. 1988; 68:1185–1200.

25. Chang YT, Lin JY, Huang YS. Typhoid colonic perforation in childhood: a ten-year experience. World J Surg. 2006; 30:242–247.

26. Vargas M, Peña A. Toxic amoebic colitis and amoebic colon perforation in children: an improved prognosis. J Pediatr Surg. 1976; 11:223–225.

27. Bar-Joseph G, Halberthal M, Sweed Y, Bialik V, Shoshani O, Etzioni A. Clostridium septicum infection in children with cyclic neutropenia. J Pediatr. 1997; 131:317–319.