Abdominal foregut perforations in children: a 10-year experience.
OBJECTIVE
Intraabdominal foregut perforations in children are rare. We conducted a retrospective review with the aim of defining their etiologies, treatment, outcomes, and prognosis.


METHODS
Abdominal foregut perforations treated during a 10-year period were reviewed. Perforations secondary to blunt or penetrating trauma and inadvertent perforations sustained, recognized, and repaired during surgical procedures, were excluded.


RESULTS
Fourteen perforations were identified, including 1 esophageal, 8 gastric, and 5 duodenal perforations. Seven perforations (50%) occurred in the neonatal period. Of the 7 neonates, 3 (43%) were premature. Nine patients (64%) had significant comorbidities. Six (43%) perforations were spontaneous, 5 (36%) were iatrogenic, and 3 (21%) were direct complications of underlying conditions. Primary repair of the perforation was completed in 11 patients (79%), and staged repair in 1 patient. Significant morbidities related to the perforation occurred in 36% of patients. Twelve patients (86%) survived to discharge. The 10 long-term survivors are on full oral feeds.


CONCLUSIONS
Pediatric abdominal foregut perforations have diverse etiologies. Half occur in neonates, evenly divided between term and premature babies. Major comorbidities are common. One third are iatrogenic and potentially preventable. Primary repair should be performed when feasible. Patients who survive the initial complications have excellent long-term outcomes.
Abadir
Janet
J
Division of Pediatric Surgery, Department of Surgery, University of California, Irvine Children's Hospital, Orange, CA 92868-3298, USA.
Emil
Sherif
S
Nguyen
Nam
N
D000007:Abdominal Injuries / Q000150:complications; D000293:Adolescent; D002648:Child; D015897:Comorbidity; D004939:Esophageal Perforation / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007223:Infant; D007231:Infant, Newborn; D007416:Intestinal Perforation / Q000473:pathology* / Q000601:surgery*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D013270:Stomach / Q000293:injuries* / Q000473:pathology; D016019:Survival Analysis