Perforation of the colon in neonates.
OBJECTIVE
Gastrointestinal perforation is a catastrophic condition in neonates, especially in premature neonates. Although perforation is commonly observed in the small intestine during the neonatal period, perforation of the colon is a rare condition. This study analyzed the clinical findings and results of perforation of the colon in neonates.


METHODS
Between 1989 and 2004, 8 neonates were treated for spontaneous perforation of the colon at our institute. These patients were retrospectively reviewed.


RESULTS
Gestational ages ranged from 36 to 41 weeks. Seven patients weighed above 2500 g, whereas one patient weighed 1800 g at birth. Perforations developed within 7 days after birth in 6 patients and before birth in two. Associated bowel diseases included rectosigmoid type of Hirschsprung's disease in two patients, immature ganglia in one, imperforate anus in one, colonic atresia in one, and necrotizing enterocolitis in one. An obvious cause was not identified in the remaining two. Six patients without definite anatomic obstructions, such as imperforate anus or colonic atresia, required evaluations for suspected Hirschsprung's disease. All 8 patients underwent colostomy and recovered from peritonitis. Seven survived, but one died of sudden infant death syndrome.


CONCLUSIONS
In this study, perforation of the colon during the neonatal period mostly occurred in term or near-term neonates and carried a good prognosis. During management, it was important to identify Hirschsprung's and its allied disorders as a cause of perforation.
Komuro
Hiroaki
H
Department of Pediatric Surgery, Graduate School of Comprehensive Human Sciences and University Hospital, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan. hiro-kom@md.tsukuba.ac.jp
Urita
Yasuhisa
Y
Hori
Tetsuo
T
Hirai
Misako
M
Kudou
Sumi
S
Gotoh
Chikashi
C
Kawakami
Hajime
H
Kaneko
Michio
M
D003108:Colonic Diseases / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D003125:Colostomy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000150:complications; D007416:Intestinal Perforation / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D008297:Male; D010538:Peritonitis / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D013398:Sudden Infant Death; D016896:Treatment Outcome