Treatment of intestinal perforation in extremely low-birthweight infants.
BACKGROUND
The mortality of intestinal perforation in extremely low-birthweight infants (ELBWI) is high. It still remains to be determined whether peritoneal drainage is a definitive treatment instead of laparotomy. The authors used bedside peritoneal drainage (BSPD) as the diagnostic procedure, and exchange transfusion (ET) as the preparatory procedure for invasive stress of laparotomy. The treatment protocol is composed primarily of laparotomy combined with BSPD and ET.


METHODS
ELBWI who developed intestinal perforation during hospitalization between 1993 and 2000 were treated according to the aforementioned protocol. Their medical records were examined retrospectively.


RESULTS
Eight ELBWI were identified. The subjects' birthweights ranged from 553 to 892 g and the gestational age ranged from 23 to 26 weeks. The subjects consisted of five cases with idiopathic intestinal perforation, two cases with necrotizing enterocolitis, and one case with meconium plug syndrome. Laparotomy was performed in all cases, and BSPD was performed in seven cases. Intestinal perforation was definitively diagnosed by X-ray only in three cases, while by stool-like drainage in BSPD in the other five cases. Seven (87.5%) cases survived.


CONCLUSIONS
In this limited experience, the treatment mainly composed of laparotomy combined with BSPD and ET appeared beneficial.
Kawakami
Akihiro
A
Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. kawakamiakihiro@kantoh.rofuku.go.jp
Shirakawa
Yoshitsugu
Y
Shirahata
Akira
A
Yano
Kouichi
K
Morita
Masaru
M
Yasumoto
Kimimasa
K
D004322:Drainage; D005078:Exchange Transfusion, Whole Blood; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D019102:Infant, Very Low Birth Weight; D007416:Intestinal Perforation / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies