Risk factors analysis of gastrointestinal perforation in anorectal malformations / 中华实用儿科临床杂志

ABSTRACT

Objective To analyze clinical data of anorectal malformations(ARM)in children with gastrointes-tinal perforation and explore the features and risk factors associated with gastrointestinal perforation. Methods A retro-spective review was performed in all children with ARM at the Second Affiliated Hospital of Xi′an Jiaotong University from September 2011 to September 2016. The association between gastrointestinal perforations and other factors were statistically analyzed,such as low birth weight,premature birth,delayed diagnosis,and the type of ARM. Based on the related literatures obtained from PubMed,Web of Science and Wanfang database,the clinical characteristics were ex-plored in patients with gastrointestinal perforation complicated with ARM. Results A total of 143 patients with ARM were included in the study,of whom 17 cases belonged to delayed diagnosis,16 cases with low birth weight patients,21 case were premature infants. In all patients,3 patients were complicated with gastrointestinal perforation,and the diagnosis of 2 cases were delayed,2 cases had low birth weight,1 case was premature infant,and the perforation sites were all loca-ted in the sigmoid colon or rectum. Statistical analysis showed that perforation was associated with delayed diagnosis(P =0. 037)and low birth weight(P = 0. 033),however,perforation was not associated with prematurity(P = 0. 381)or the type of ARM(χ2 =0. 000,P =1. 000). A total of 23 cases with complete clinical data in 15 English literatures and 3 cases in the Second Affiliated Hospital of Xi′an Jiaotong University were summarized. The reviewing showed that 92％ of perfo-rations occurred before surgical decompression of the obstructed colon,and 68％ of perforations occurred in the sigmoid colon or rectum. Conclusions Gastrointestinal perforation is a rare complication in ARM. And it is associated with delayed diagnosis,as well as low birth weight or the distal bowel canal underdevelopment. Careful perineal examination will clearly identify the existence of ARM and therefore delayed diagnosis can be totally avoided. Thus,the incidence of bowel perforation in patients with ARM can be reduced effectively.