Comparative study between isolated intestinal perforation and necrotizing enterocolitis.
BACKGROUND
Intestinal perforations in the neonatal period are usually related to necrotizing enterocolitis (NEC) or intestinal occlusion. Intestinal perforation in the absence of these conditions is called isolated perforation (IP). Several risk factors and pathogenic mechanisms have been suggested, and most of them are common to those classically attributed to NEC.


OBJECTIVE
To identify and compare the clinical and pathological features of IP and NEC.


METHODS
We reviewed all cases of neonatal intestinal perforation and NEC in the last five years. Thirty-three patients were retrospectively classified into Group NEC: 24 cases, and Group IP: 9 cases. We collected multiple data as study variables: 1) General features; 2) Obstetric history; 3) Neonatal treatment; 4) Comorbidity; 5) Perforation features; 6) Treatment and outcome.


RESULTS
Comparing the groups, we found statistical significant differences in isolated perforation cases with these risk factors: extreme prematurity, very low birth weight, abruptio placenta, intubation and neonatal mechanical ventilation, umbilical catheterization, precocious sepsis, and indomethacin therapy. A more precocious operation and a good prognosis also reached statistical significance. In the other hand, we found statistically significant differences in NEC with congenital cardiopathy (excluding isolated patent ductus arteriosus), with intestinal pneumatosis, with diffuse bowel involvement and a worse prognosis. Risk factors and pathologic findings seem to support an ischaemic pathogenesis in both diseases.
Tarrado
X
X
Servei de Cirurgia Pediàtrica, Unitat Integrada, Hospital Sant Joan de Déu/Hospital Clínic, Barcelona, Universitat de Barcelona, Spain. xtarrado@hsjdbcn.org
Castañón
M
M
Thió
M
M
Valderas
J M
JM
Garcia Aparicio
L
L
Morales
L
L
D020345:Enterocolitis, Necrotizing / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007416:Intestinal Perforation / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D007422:Intestines / Q000098:blood supply*; D007511:Ischemia / Q000150:complications*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors