Neonatal Gastrointestinal Perforation

ABSTRACT

Perforation of the gastrointestinal tract in neonatal period has been associated with a grim prognosis even with some improvement in survival. To evaluate the remaining pitfalls in management, 19 cases of neonatal gastrointestinal perforation from May 1989 to July 1996 were analysed retrospectively. Seven of them were premature and low birth weight infants. Perforation was most common in ileum (56.3%). Mechanical or functional obstruction distal to the perforation site was identified in 7 cases, such as 3 of Hirschsprung's disease, 3 of small bowel atresia, and 1 of anorectal malformation. Among them, 2 of Hirschsprung's disease, 1 of small bowel atresia, and one anorectal malformation could be diagnosed only after perforation. Five cases of necrotizing enterocolitis and 1 of muscular defect were the other causes of perforation. But in 6 cases, a preceding cause was not identified. Perinatal ischemic episodes were associated in five cases. Overall mortality rate was 15.1%. Because a considerable number of gastrointestinal perforations were resulted from distal obstruction, pediatric surgeon should be alert for early identification and intervention of gastrointestinal obstruction, particularly in prematurity and history of ischemia.