title: Spontaneous Intestinal Perforation: The Long-Term Outcome.
abstract: Background/PurposeEvaluating the long-term outcome of spontaneous intestinal perforation (SIP).MethodsWe studied all patients treated for SIP at our institution between January 1, 2005 and December 31, 2014.ResultsTwenty-three infants (13 males) with a median gestational age of 26 (range: 23-32) weeks and a median weight of 825 (range: 560-1,965) g composed this cohort. Seventeen (74%) infants had an extremely low birth weight (ELBW); nine (39%) infants were the result of multiple pregnancies.Patent ductus arteriosus (PDA) was present in 16 (70%) infants. Cyclooxygenase inhibitors were administered in 12 (52%) infants.Ten infants (seven males, 44%) were diagnosed with intraventricular hemorrhage (IVH), which was identified in the majority (8/10) at a median of 9 (range: 1-11) days prior to the perforation.All patients presented with pneumoperitoneum and underwent a laparotomy at a median age of 9 (range: 2-16) days. Twenty-one patients had an ileal perforation. A temporary stoma was placed in 21 patients, whereas two got primary anastomosis. Two (8.7%) male infants died. During the long-term follow-up period (median 6 years), six (five males) (26%) infants developed moderate to severe disabilities in combination with cerebral palsy. No surgical complications were observed.ConclusionThe most important risk factor for SIP is ELBW (75%). The distal ileum is the most frequent site of perforation (88%). Approximately 40% develop IVH most often prior to the SIP. Moderate to severe neurologic disabilities are seen in more than a quarter of the children. Disability and mortality affect mostly the male sex. Long-term risks of surgical complications are very low.
authors.affiliation: Department of Surgery, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
authors.forename: Christoph Heinrich
authors.initials: CH
authors.lastname: Houben
authors.affiliation: Department of Statistics, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
authors.forename: Xiang-Nan
authors.initials: XN
authors.lastname: Feng
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
authors.forename: Kin Wai Edwin
authors.initials: KWE
authors.lastname: Chan
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
authors.forename: Jennifer Wai Cheung
authors.initials: JWC
authors.lastname: Mou
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
authors.forename: Yuk Him
authors.initials: YH
authors.lastname: Tam
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
authors.forename: Kim Hung
authors.initials: KH
authors.lastname: Lee
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D007223:Infant; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D007416:Intestinal Perforation / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D008297:Male; D011379:Prognosis; D012307:Risk Factors