Gastrointestinal perforation an peritonitis in infants and children: experience with 179 cases over ten years

J. L. Grosfeld, F. Molinari, M. Chaet, S. A. Engum, K. W. West, Frederick Rescorla, L. R. Tres Scherer, M. Klein, F. Alexander, A. Leonard, D. Silver

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Abstract

Background. Premature infants continue to have a high mortality after gastrointestinal perforation and peritonitis and compares etiologic factors, mortality, and causes of death in premature infants and older children in an attempt to predict outcome. Methods. The 113 boys (63.1%) and 66 girls (36.9%) had an age range of newborn (n = 139, 77.6%) to 17 years.Site of perforation was gastric in 16, duodenal in 9, small bowel in 105, colon in 37, and undesignated in 12. Eighteen had multiple perforations. Etiologic factors in newborn (younger than 2 months) included necrotizing enterocolitis (NEC) (75, 41.9%), isolated ileal perforations (30, 21.5%), malrotation/volvulus (8), iatrogenic causes (5), and others (6). Gestational age was 29.6 ± 4.3 weeks for NEC versus 31.4 ± 5.4 weeks for non-NEC. Birth weight for patients with NEC was 1.45 ± 0.8 gm and 1.81 ± 1.0 gm for non- NEC babies. Etiologic factors in 33 older children (older than 2 months to 17 years) were trauma (10), Meckel's diverticulum (4), intussusception (2), pseudomembranous colitis (2), adhesions (2), stomal leak (2), others (4), and nondesignated (7). Gastric perforations (n = 6) were iatrogenic in 7, idiopathic in 5, and caused by an ulcer in 4. Results. Mortality for NEC was 36 of 75 (48%), 15 of 55 (27.2%) for non-NEC infants (p < 0.05 versus NEC), 15.1% (5 of 33) for older children (p< 0.05 versus NEC), and 4 of 16 (25%) for multiorgan failure. Deaths for older children were a result of sepsis, multiorgan failure, and immunodeficiency. Conclusions. Gastrointestinal perforation is more common in premature infants with the highest mortality (48%) noted in NEC. Despite surgical intervention and advances in neonatal intensive care unit care, premature low both weight infants (especially NEC) continue to have a high mortality.

Original languageEnglish
Pages (from-to)650-656
Number of pages7
JournalSurgery
Volume120
Issue number4
DOIs
StatePublished - 1996

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Necrotizing Enterocolitis
Peritonitis
Premature Infants
Mortality
Enterocolitis
Stomach
Newborn Infant
Pseudomembranous Enterocolitis
Meckel Diverticulum
Intestinal Volvulus
Intussusception
Neonatal Intensive Care Units
Birth Weight
Gestational Age
Ulcer
Cause of Death
Sepsis
Colon
Weights and Measures

ASJC Scopus subject areas

  • Surgery

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Gastrointestinal perforation an peritonitis in infants and children : experience with 179 cases over ten years. / Grosfeld, J. L.; Molinari, F.; Chaet, M.; Engum, S. A.; West, K. W.; Rescorla, Frederick; Tres Scherer, L. R.; Klein, M.; Alexander, F.; Leonard, A.; Silver, D.

In: Surgery, Vol. 120, No. 4, 1996, p. 650-656.

Research output: Contribution to journalArticle

Grosfeld, JL, Molinari, F, Chaet, M, Engum, SA, West, KW, Rescorla, F, Tres Scherer, LR, Klein, M, Alexander, F, Leonard, A & Silver, D 1996, 'Gastrointestinal perforation an peritonitis in infants and children: experience with 179 cases over ten years', Surgery, vol. 120, no. 4, pp. 650-656. https://doi.org/10.1016/S0039-6060(96)80012-2
Grosfeld, J. L. ; Molinari, F. ; Chaet, M. ; Engum, S. A. ; West, K. W. ; Rescorla, Frederick ; Tres Scherer, L. R. ; Klein, M. ; Alexander, F. ; Leonard, A. ; Silver, D. / Gastrointestinal perforation an peritonitis in infants and children : experience with 179 cases over ten years. In: Surgery. 1996 ; Vol. 120, No. 4. pp. 650-656.
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title = "Gastrointestinal perforation an peritonitis in infants and children: experience with 179 cases over ten years",
abstract = "Background. Premature infants continue to have a high mortality after gastrointestinal perforation and peritonitis and compares etiologic factors, mortality, and causes of death in premature infants and older children in an attempt to predict outcome. Methods. The 113 boys (63.1{\%}) and 66 girls (36.9{\%}) had an age range of newborn (n = 139, 77.6{\%}) to 17 years.Site of perforation was gastric in 16, duodenal in 9, small bowel in 105, colon in 37, and undesignated in 12. Eighteen had multiple perforations. Etiologic factors in newborn (younger than 2 months) included necrotizing enterocolitis (NEC) (75, 41.9{\%}), isolated ileal perforations (30, 21.5{\%}), malrotation/volvulus (8), iatrogenic causes (5), and others (6). Gestational age was 29.6 ± 4.3 weeks for NEC versus 31.4 ± 5.4 weeks for non-NEC. Birth weight for patients with NEC was 1.45 ± 0.8 gm and 1.81 ± 1.0 gm for non- NEC babies. Etiologic factors in 33 older children (older than 2 months to 17 years) were trauma (10), Meckel's diverticulum (4), intussusception (2), pseudomembranous colitis (2), adhesions (2), stomal leak (2), others (4), and nondesignated (7). Gastric perforations (n = 6) were iatrogenic in 7, idiopathic in 5, and caused by an ulcer in 4. Results. Mortality for NEC was 36 of 75 (48{\%}), 15 of 55 (27.2{\%}) for non-NEC infants (p < 0.05 versus NEC), 15.1{\%} (5 of 33) for older children (p< 0.05 versus NEC), and 4 of 16 (25{\%}) for multiorgan failure. Deaths for older children were a result of sepsis, multiorgan failure, and immunodeficiency. Conclusions. Gastrointestinal perforation is more common in premature infants with the highest mortality (48{\%}) noted in NEC. Despite surgical intervention and advances in neonatal intensive care unit care, premature low both weight infants (especially NEC) continue to have a high mortality.",
author = "Grosfeld, {J. L.} and F. Molinari and M. Chaet and Engum, {S. A.} and West, {K. W.} and Frederick Rescorla and {Tres Scherer}, {L. R.} and M. Klein and F. Alexander and A. Leonard and D. Silver",
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T1 - Gastrointestinal perforation an peritonitis in infants and children

T2 - experience with 179 cases over ten years

AU - Grosfeld, J. L.

AU - Molinari, F.

AU - Chaet, M.

AU - Engum, S. A.

AU - West, K. W.

AU - Rescorla, Frederick

AU - Tres Scherer, L. R.

AU - Klein, M.

AU - Alexander, F.

AU - Leonard, A.

AU - Silver, D.

PY - 1996

Y1 - 1996

N2 - Background. Premature infants continue to have a high mortality after gastrointestinal perforation and peritonitis and compares etiologic factors, mortality, and causes of death in premature infants and older children in an attempt to predict outcome. Methods. The 113 boys (63.1%) and 66 girls (36.9%) had an age range of newborn (n = 139, 77.6%) to 17 years.Site of perforation was gastric in 16, duodenal in 9, small bowel in 105, colon in 37, and undesignated in 12. Eighteen had multiple perforations. Etiologic factors in newborn (younger than 2 months) included necrotizing enterocolitis (NEC) (75, 41.9%), isolated ileal perforations (30, 21.5%), malrotation/volvulus (8), iatrogenic causes (5), and others (6). Gestational age was 29.6 ± 4.3 weeks for NEC versus 31.4 ± 5.4 weeks for non-NEC. Birth weight for patients with NEC was 1.45 ± 0.8 gm and 1.81 ± 1.0 gm for non- NEC babies. Etiologic factors in 33 older children (older than 2 months to 17 years) were trauma (10), Meckel's diverticulum (4), intussusception (2), pseudomembranous colitis (2), adhesions (2), stomal leak (2), others (4), and nondesignated (7). Gastric perforations (n = 6) were iatrogenic in 7, idiopathic in 5, and caused by an ulcer in 4. Results. Mortality for NEC was 36 of 75 (48%), 15 of 55 (27.2%) for non-NEC infants (p < 0.05 versus NEC), 15.1% (5 of 33) for older children (p< 0.05 versus NEC), and 4 of 16 (25%) for multiorgan failure. Deaths for older children were a result of sepsis, multiorgan failure, and immunodeficiency. Conclusions. Gastrointestinal perforation is more common in premature infants with the highest mortality (48%) noted in NEC. Despite surgical intervention and advances in neonatal intensive care unit care, premature low both weight infants (especially NEC) continue to have a high mortality.

AB - Background. Premature infants continue to have a high mortality after gastrointestinal perforation and peritonitis and compares etiologic factors, mortality, and causes of death in premature infants and older children in an attempt to predict outcome. Methods. The 113 boys (63.1%) and 66 girls (36.9%) had an age range of newborn (n = 139, 77.6%) to 17 years.Site of perforation was gastric in 16, duodenal in 9, small bowel in 105, colon in 37, and undesignated in 12. Eighteen had multiple perforations. Etiologic factors in newborn (younger than 2 months) included necrotizing enterocolitis (NEC) (75, 41.9%), isolated ileal perforations (30, 21.5%), malrotation/volvulus (8), iatrogenic causes (5), and others (6). Gestational age was 29.6 ± 4.3 weeks for NEC versus 31.4 ± 5.4 weeks for non-NEC. Birth weight for patients with NEC was 1.45 ± 0.8 gm and 1.81 ± 1.0 gm for non- NEC babies. Etiologic factors in 33 older children (older than 2 months to 17 years) were trauma (10), Meckel's diverticulum (4), intussusception (2), pseudomembranous colitis (2), adhesions (2), stomal leak (2), others (4), and nondesignated (7). Gastric perforations (n = 6) were iatrogenic in 7, idiopathic in 5, and caused by an ulcer in 4. Results. Mortality for NEC was 36 of 75 (48%), 15 of 55 (27.2%) for non-NEC infants (p < 0.05 versus NEC), 15.1% (5 of 33) for older children (p< 0.05 versus NEC), and 4 of 16 (25%) for multiorgan failure. Deaths for older children were a result of sepsis, multiorgan failure, and immunodeficiency. Conclusions. Gastrointestinal perforation is more common in premature infants with the highest mortality (48%) noted in NEC. Despite surgical intervention and advances in neonatal intensive care unit care, premature low both weight infants (especially NEC) continue to have a high mortality.

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