Evaluation of the management of intestinal perforation in very low birth infants, a 10‐year review

• Published in: Acta Paediatrica Vol. 113; no. 4; pp. 733 - 738
• Main Authors: Raba, Ali Ahmed, Coleman, John, Cunningham, Katie
• Format: Journal Article
• Language: English
• Published: Norway Wiley Subscription Services, Inc 01-04-2024
• Subjects: Birth weight; Drainage; Enterocolitis; Gastrointestinal diseases; Infants; Intestine; Laparotomy; necrotising enterocolitis; Necrotizing enterocolitis; peritoneal drainage; Peritoneum; preterm infants; spontaneous intestinal perforation; Surgical drains; spontaneous intestinal perforation; necrotising enterocolitis; preterm infants; laparotomy; peritoneal drainage
• ISSN: 0803-5253; 1651-2227; 1651-2227
• DOI: 10.1111/apa.17069

Aim
The aim of this study was to assess outcomes of peritoneal drainage and laparotomy in the management of intestinal perforation secondary to necrotizing enterocolitis (NEC) and spontaneous intestinal perforation.
Methods
A retrospective review of all preterm infants (birthweight ≤1500 g) who underwent surgical intervention (peritoneal drainage and/or laparotomy) for intestinal perforation between March 2010 and March 2020.
Results
A total of 43 infants who underwent surgical intervention for intestinal perforation were included [19 (44%) with NEC and 24 (56%) with spontaneous intestinal perforation]. Peritoneal drainage was more commonly placed as the initial surgical procedure for management of spontaneous intestinal perforation compared with surgical NEC [23 (96%) vs. 11 (58%), p = 0.003]. Mortality was greater for infants who were initially managed with peritoneal drainage [11 (32%)] compared with those who underwent primary laparotomy [2 (22%), p = 0.5].
Conclusion
Initial surgical management of intestinal perforation is more often according to underlying pathology. Our data support primary laparotomy for infants with perforated NEC.