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, F. J. 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 (US)
Pages (from-to)650-656
Number of pages7
JournalSurgery
Volume120
Issue number4
DOIs
StatePublished - Jan 1 1996

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ASJC Scopus subject areas

  • Surgery

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Grosfeld, J. L., Molinari, F., Chaet, M., Engum, S. A., West, K. W., Rescorla, F. J., Tres Scherer, L. R., 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, 120(4), 650-656. https://doi.org/10.1016/S0039-6060(96)80012-2