Practical experience in the surgical treatment of newborns with isolated gastrointestinal perforations based on scientific evidence

Abstract

OBJECTIVE: Aim: To share first-hand experience in the surgical treatment of newborns with isolated gastrointestinal perforations. PATIENTS AND METHODS: Materials and Methods: This study examines 71 newborns with perforated peritonitis: 53 (74.65%) had necrotizing enterocolitis, 14 (19.72%) had isolated gastrointestinal perforations, and 4 (5.63%) had other intestinal perforations. Diagnosis involved clinical, laboratory, radiographic, ultrasound, and histological examinations of surgical and autopsy samples. RESULTS: Results: The most significant risk factors for isolated perforations of the gastrointestinal tract in newborns were acute birth asphyxia and pathology of the respiratory system, which required tracheal intubation in 100% of children. Isolated perforations were localized in the stomach (n=6), jejunum (n=3), ileum (n=2), duodenum (n=1), colon (n=2). Morphological features of isolated perforations are as follows: a rapid muscle layer wasting of the wall, sometimes with the absence of muscle fragments; vascular malformations in the submucosal layer of the wall; ulcerous defect without necrotic changes; absence of pneumatosis of the intestinal wall. In isolated perforations, the operation of choice was closure of perforation in 11 children. In 2 patients direct interintestinal anastomoses were performed. Case mortality rate was 21.43% (3 newborns died). CONCLUSION: Conclusions: 1. Clinical and pathomorphological features of gastrointestinal perforations in newborns indicate that isolated perforations are a separate nosological entity. 2. Isolated perforations of the gastrointestinal tract in newborns are characterized by such clinical differences as distress syndrome, prematurity, early onset, local lesions of a hollow organ, moderate peritonitis, favorable course and prognosis. 3. Isolated perforations are secondary to fibromuscular dysplasia of the wall of a hollow organ, indicating congenital pathology. 4. The operation of choice for isolated perforations is the excision of the edges of the perforation and closure of the perforation. 5. The prognosis for the gastrointestinal isolated perforations is favorable. Mortality was 21,43%.