Clinical analysis of 8 cases of neonatal intestinal muscle defect with perforation / 中华实用儿科临床杂志

ABSTRACT

Objective To study the clinical characteristics,treatment and prognosis of neonatal intestinal muscle defect with perforation.Methods The clinical data of 8 cases of newborns who had intestinal muscle defect with perforation in Department of Surgical Intensive Care Unit,Nanjing Children's Hospital Affiliated to Nanjing Medical University,were analyzed retrospectively.Results These 8 cases included 1 premature infant,1 term low birth weight infant,6 cases of term infants with normal birth weight,and all had no history of perinatal asphyxia.The ages of onset of all cases were ＜ 7 d.Clinical manifestations were crying and sudden onset of obvious abdominal distention.Bile or fecal vomiting occurred in 5 cases.These patients included 5 cases with congenital anorectal malformations,of which 3 cases had low deformity,1 case with middle deformity and 1 case with high deformity,with no other complications of gastrointestinal malformation.Surgical treatment was used in 8 cases,in which 7 cases of rectal perforation and 1 case of ileal perforation were confirmed.All cases were isolated perforation with a diameter of about 0.8-2.0 cm.The perforated periphery of the intestine was membranous.Intestinal repair was performed after total removal of the diseased tissue,and the patients with rectal perforation were performed at the same time for the proximal colostomy.The histopathologic examinations showed that the periphery of perforation had intact mucosa,muscularis propria was absent,myenteric plexus was absent in the region of muscle loss.Two cases were discharged within 1 d after colostomy.Except for 1 case with high anorectal malformation in the control of poor defecation functions,there were no other postoperative gastrointestinal complications in these 6 cases.Conclusions Rectal perforation is the most common in neonatal intestinal muscle defects,and it is an isolated and large diameter perforation.Most cases are term infants with normal birth weight.These patients are often associated with congenital anorectal malformations.High,middle and low deformity can be accompanied by intestinal muscle defect.Surgical excision of diseased tissue should be complete,in principle,and intestinal stoma should be performed proximal to the perforation.In case of congenital anorectal malformations complicated with gastrointestinal perforation,the rectum should be explored as an important region.Neonatal intestinal muscle defect maybe a primary lesion according to clinical characteristics of early sudden onset after birth and pathological examinations.Except for complications caused by associated malformations,the prognosis is satisfactory.