Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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Comparison of gastric and other bowel perforations in preterm infants: a review of 20 years' experience in a single institution

  • Lee, Do Kyung (Department of Pediatrics, Ewha Womans University School of Medicine) ;
  • Shim, So Yeon (Department of Pediatrics, Ewha Womans University School of Medicine) ;
  • Cho, Su Jin (Department of Pediatrics, Ewha Womans University School of Medicine) ;
  • Park, Eun Ae (Department of Pediatrics, Ewha Womans University School of Medicine) ;
  • Lee, Sun Wha (Department of Radiology, Ewha Womans University School of Medicine)
  • 투고 : 2014.07.28
  • 심사 : 2014.10.20
  • 발행 : 2015.08.10
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초록

Purpose: In this study, we aimed to review the clinical presentation of preterm infants with gastrointestinal perforations and compare the clinical features of gastric perforation with other intestinal perforations. Methods: The medical records of preterm neonates with pneumoperitoneum, admitted to the neonatal intensive care unit (NICU) between January 1994 and December 2013, were retrospectively reviewed. Results: Twenty-one preterm infants underwent exploratory laparotomy to investigate the cause of the pneumoperitoneum. The sample consisted of five patients (23.8%) with gastric perforation and 16 patients (76.2%) with intestinal perforation. No statistical differences were found in the birth history and other perinatal factors between the two groups. Underlying necrotizing enterocolitis, bilious vomiting, and paralytic ileus preceding the perforation were statistically more common in the intestinal perforation group. All preterm infants with gastric perforation survived to discharge; however, six preterm infants with intestinal perforation expired during treatment in the NICU. In the gastric perforation group, sudden pneumoperitoneum was the most common finding, and the mean age at diagnosis was $4.4{\pm}1.7days$ of life. The location and size of the perforations varied, and simple closure or partial gastrectomy was performed. Conclusion: Patients with gastric perforation did not have a common clinical finding preceding the perforation diagnosis. Although mortality in previous studies was high, all patients survived to discharge in the present study. When a preterm infant aged less than one week presents with sudden abdominal distension and pneumoperitoneum, gastric perforation should first be excluded. Prompt exploratory laparotomy will increase the survival rates of these infants.

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참고문헌

  1. Grosfeld JL, Molinari F, Chaet M, Engum SA, West KW, Rescorla FJ, et al. Gastrointestinal perforation and peritonitis in infants and children: experience with 179 cases over ten years. Surgery 1996;120:650-5. https://doi.org/10.1016/S0039-6060(96)80012-2
  2. Lin CM, Lee HC, Kao HA, Hung HY, Hsu CH, Yeung CY, et al. Neonatal gastric perforation: report of 15 cases and review of the literature. Pediatr Neonatol 2008;49:65-70. https://doi.org/10.1016/S1875-9572(08)60015-7
  3. Fenton TR. A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format. BMC Pediatr 2003;3:13. https://doi.org/10.1186/1471-2431-3-13
  4. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978;187:1-7. https://doi.org/10.1097/00000658-197801000-00001
  5. Hamrick SE, Hansmann G. Patent ductus arteriosus of the preterm infant. Pediatrics 2010;125:1020-30. https://doi.org/10.1542/peds.2009-3506
  6. Salafia CM, Weigl C, Silberman L. The prevalence and distribution of acute placental inflammation in uncomplicated term pregnancies. Obstet Gynecol 1989;73(3 Pt 1):383-9.
  7. Calisti A, Perrelli L, Nanni L, Vallasciani S, D'Urzo C, Molle P, et al. Surgical approach to neonatal intestinal perforation. An analysis on 85 cases (1991-2001). Minerva Pediatr 2004;56:335-9.
  8. Rosser SB, Clark CH, Elechi EN. Spontaneous neonatal gastric perforation. J Pediatr Surg 1982;17:390-4. https://doi.org/10.1016/S0022-3468(82)80496-X
  9. Miller RA. Observations on the gastric acidity during the first month of life. Arch Dis Child 1941;16:22-30. https://doi.org/10.1136/adc.16.85.22
  10. Touloukian RJ. Gastric ischemia: the primary factor in neonatal perforation. Clin Pediatr (Phila) 1973;12:219-25.
  11. Ohshiro K, Yamataka A, Kobayashi H, Hirai S, Miyahara K, Sueyoshi N, et al. Idiopathic gastric perforation in neonates and abnormal distribution of intestinal pacemaker cells. J Pediatr Surg 2000;35:673-6. https://doi.org/10.1053/jpsu.2000.5940
  12. Yamataka A, Yamataka T, Kobayashi H, Sueyoshi N, Miyano T. Lack of C-KIT+ mast cells and the development of idiopathic gastric perforation in neonates. J Pediatr Surg 1999;34:34-7. https://doi.org/10.1016/S0022-3468(99)90224-5
  13. Houck WS Jr, Griffin JA 3rd. Spontaneous linear tears of the stomach in the newborn infant. Ann Surg 1981;193:763-8. https://doi.org/10.1097/00000658-198106000-00012
  14. Leone RJ Jr, Krasna IH. 'Spontaneous' neonatal gastric perforation: is it really spontaneous? J Pediatr Surg 2000;35:1066-9. https://doi.org/10.1053/jpsu.2000.7773
  15. Holgersen LO. The etiology of spontaneous gastric perforation of the newborn: a reevaluation. J Pediatr Surg 1981;16(4 Suppl 1):608-13. https://doi.org/10.1016/0022-3468(81)90014-2
  16. Shashikumar VL, Bassuk A, Pilling GP IV, Cresson SL. Spontaneous gastric rupture in the newborn: a clinical review of nineteen cases. Ann Surg 1975;182:22-5. https://doi.org/10.1097/00000658-197507000-00004
  17. Chung MT, Kuo CY, Wang JW, Hsieh WS, Huang CB, Lin JN. Gastric perforation in the neonate: clinical analysis of 12 cases. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1994;35:460-5.
  18. Kara CS, Ilce Z, Celayir S, Sarimurat N, Erdogan E, Yeker D. Neonatal gastric perforation: review of 23 years' experience. Surg Today 2004;34:243-5. https://doi.org/10.1007/s00595-003-2675-3
  19. Terui K, Iwai J, Yamada S, Takenouchi A, Nakata M, Komatsu S, et al. Etiology of neonatal gastric perforation: a review of 20 years' experience. Pediatr Surg Int 2012;28:9-14. https://doi.org/10.1007/s00383-011-3003-4
  20. Jawad AJ, Al-Rabie A, Hadi A, Al-Sowailem A, Al-Rawaf A, Abu-Touk B, et al. Spontaneous neonatal gastric perforation. Pediatr Surg Int 2002;18:396-9. https://doi.org/10.1007/s00383-002-0749-8
  21. Hwang S, Park J, Chang S. Clinical review of spontaneous gastric perforation in the newborn. J Korean Assoc Pediatr Surg 2003;9:30-4.
  22. Rhim SY, Jung PM. Clinical study of neonatal gastric perforation. J Korean Assoc Pediatr Surg 2005;11:123-30.
  23. Duran R, Inan M, Vatansever U, Aladag N, Acunas B. Etiology of neonatal gastric perforations: review of 10 years' experience. Pediatr Int 2007;49:626-30. https://doi.org/10.1111/j.1442-200X.2007.02427.x
  24. Kim EH, Kang KJ, Kim CS, Lee SL, Jung E, Choi SO, et al. Comparison of clinical findings of gastric perforation between preterm and term neonates. Korean J Perinatol 2013;24:89-94. https://doi.org/10.14734/kjp.2013.24.2.89

피인용 문헌

  1. Neonatal gastric perforations in very low birth weight infants: a single center experience and review of the literature vol.34, pp.1, 2015, https://doi.org/10.1007/s00383-017-4205-1
  2. Pathogenetic and Prognostic Factors for Neonatal Gastric Perforation: Personal Experience and Systematic Review of the Literature vol.6, pp.None, 2015, https://doi.org/10.3389/fped.2018.00061