title: Spontaneous localized intestinal perforation and intestinal dilatation in very-low-birthweight infants.
abstract: OBJECTIVE
  To elucidate how spontaneous localized intestinal perforation (SLIP) is related to intestinal morphological features such as dilatation in very-low-birthweight (VLBW) infants.
  
  
  METHODS
  The medical records of 13 VLBW infants (<1500 g) undergoing laparotomy between 1983 and 2003 for presumed SLIP were retrospectively reviewed. Clinical findings including maternal, prenatal and perinatal factors were analysed, and the clinical and surgical findings upon laparotomy were compared.
  
  
  RESULTS
  Postnatal pathological conditions included patent ductus arteriosus (n=7), sepsis (n=2), respiratory distress syndrome (n=7), intraventricular haemorrhage (n=2), an indwelling catheter via the umbilical vein (n=1) and pneumonia (n=1). Indomethacin was used in seven neonates with patent ductus arteriosus, and dexamethasone preventive therapy was employed in one neonate for bronchopulmonary dysplasia. Operative findings revealed a localized small punched-out perforation in the ileum. Five patients had intestinal dilatation: two with a perforation in the middle of the dilated intestine, and three with a perforation proximal to the region of dilatation. The muscularis propria was absent in the dilated intestine of four patients.
  
  
  CONCLUSIONS
  This study found no significant relationship between perforation and dilatation of the intestine. Perforation may occur in any portion of the ischaemic intestine when circulatory failure becomes severe, and is not necessarily restricted to the dilated intestine. We believe that SLIP and intestinal dilatation may occur on the same basis in low-birthweight infants; however, the disease process may be aetiologically different.
authors.affiliation: Division of Paediatric Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan. tkoshina@med.nihon-u.ac.jp
authors.forename: Tsugumichi
authors.initials: T
authors.lastname: Koshinaga
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Gotoh
authors.forename: Kiminobu
authors.initials: K
authors.lastname: Sugito
authors.forename: Tarou
authors.initials: T
authors.lastname: Ikeda
authors.forename: Noritsugu
authors.initials: N
authors.lastname: Hagiwara
authors.forename: Ryouichi
authors.initials: R
authors.lastname: Tomita
mesh_terms: D004108:Dilatation, Pathologic; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D019102:Infant, Very Low Birth Weight; D007410:Intestinal Diseases / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D007416:Intestinal Perforation / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies