Neonatal intestinal perforation; laparotomy versus drainage

ABSTRACT

This study included 25 cases of intestinal perforation with and without necrotizing enterocolitis [NEC]. Infants were divided into two groups Group 1 consisted of 8 infants who had intestinal perforation without evidence of NEC and group 2 consisted of 17 infants who had intestinal perforation with evidences of NEC. A total of 25 infants underwent initial peritoneal damage [PD] for intestinal perforation. In addition, a cohort of 10 infants was obtained by a chart review of premature infants with intestinal perforation treated with primary laparotomy. Outcome of the cohort group was compared with those of the infants treated with primary PD. All infants showed initial improvements after PD. In group 1, all infants survived. Five infants never required laparotomy and drain was removed after 10 +/- 7 days. One infant underwent laparotomy after 48 hours due to failure of improvement, an isolated perforation was found, a diverting stoma was placed, and the infant recovered. Two infants required laparotomy 15 and 17 days after PD. In group 2, all infants improved systemically immediately after PD. Seven infants survived required no additional surgical intervention and all were discharged with intact gastrointestinal function. Four infants developed clinical deterioration and underwent salvage LAP, three underwent bowel resection and placement of diverting stoma and recovered and one had total intestinal necrosis and died. The remaining six infants died without exploration