Spontaneous Intestinal Perforation: The Long-Term Outcome

Abstract

Background/Purpose Evaluating the long-term outcome of spontaneous intestinal perforation (SIP).

Methods We studied all patients treated for SIP at our institution between January 1, 2005 and December 31, 2014.

Results Twenty-three infants (13 males) with a median gestational age of 26 (range: 23–32) weeks and a median weight of 825 (range: 560–1,965) g composed this cohort. Seventeen (74%) infants had an extremely low birth weight (ELBW); nine (39%) infants were the result of multiple pregnancies.

Patent ductus arteriosus (PDA) was present in 16 (70%) infants. Cyclooxygenase inhibitors were administered in 12 (52%) infants.

Ten infants (seven males, 44%) were diagnosed with intraventricular hemorrhage (IVH), which was identified in the majority (8/10) at a median of 9 (range: 1–11) days prior to the perforation.

All patients presented with pneumoperitoneum and underwent a laparotomy at a median age of 9 (range: 2–16) days. Twenty-one patients had an ileal perforation. A temporary stoma was placed in 21 patients, whereas two got primary anastomosis. Two (8.7%) male infants died. During the long-term follow-up period (median 6 years), six (five males) (26%) infants developed moderate to severe disabilities in combination with cerebral palsy. No surgical complications were observed.

Conclusion The most important risk factor for SIP is ELBW (75%). The distal ileum is the most frequent site of perforation (88%). Approximately 40% develop IVH most often prior to the SIP. Moderate to severe neurologic disabilities are seen in more than a quarter of the children. Disability and mortality affect mostly the male sex. Long-term risks of surgical complications are very low.

Keywords

spontaneous intestinal perforation - necrotizing enterocolitis - male sex - intraventricular hemorrhage - neurologic disability

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