Neonatal Med.  2019 Aug;26(3):147-154. 10.5385/nm.2019.26.3.147.

Clinical or Radiological Findings Suggestive of Spontaneous Intestinal Perforation in Extremely Low Birth Weight Infants with Gasless Abdomen

Affiliations
  • 1Department of Pediatrics, Dankook University College of Medicine, Cheonan, Korea. ychang@dankook.ac.kr
  • 2Department of Pediatric Radiology, Dankook University College of Medicine, Cheonan, Korea.
  • 3Department of Pediatric Surgery, Dankook University College of Medicine, Cheonan, Korea.

Abstract

PURPOSE
This study aimed to evaluate the clinical and radiologic findings suggestive of spontaneous intestinal perforation (SIP) in extremely-low-birth-weight infants (ELBWIs) with persistent gasless abdomen, and to investigate the usefulness of abdominal ultrasonography for the diagnosis of SIP.
METHODS
In total, 22 infants with birth weights less than 1,000 g who showed persistent gasless abdomen on simple abdominal radiography were included. Perinatal, neonatal, and perioperative clinical findings were retrospectively reviewed, and the risk factors for intestinal perforation were evaluated. Abdominal sonographic findings suggestive of intestinal perforation were also identified, and postoperative short-term outcomes were evaluated.
RESULTS
In total, eight of the 22 infants (36.4%) with gasless abdomen had SIP. The number of infants with patent ductus arteriosus who were treated with intravenous ibuprofen or indomethacin was significantly higher in the SIP group than in the non-SIP group (P<0.05). Greenish or red gastric residue, abdominal distension, or decreased bowel sound were more frequent in infants with SIP (P<0.05), in addition to gray or bluish discoloration of abdomen, suggestive of meconium peritonitis (P<0.05). Pneumoperitoneum on simple abdominal radiography was found in only one of the eight infants (12.5%) with SIP. Intramural echogenicity and echogenic extramural material on abdominal ultrasonography were exclusively observed in infants with SIP. Four infants (50%) with SIP died after surgical intervention.
CONCLUSION
Intestinal perforation may occur in ELBWIs with gasless abdomen. As intramural echogenicity and extraluminal echogenic materials on abdominal ultrasonography are indicative of SIP, this technique could be useful for diagnosing SIP.

Keyword

Spontaneous intestinal perforation; Ultrasonography; Infant, extremely low birth weight

MeSH Terms

Abdomen*
Birth Weight
Diagnosis
Ductus Arteriosus, Patent
Humans
Ibuprofen
Indomethacin
Infant*
Infant, Extremely Low Birth Weight
Infant, Low Birth Weight*
Infant, Newborn
Intestinal Perforation*
Meconium
Peritonitis
Pneumoperitoneum
Radiography, Abdominal
Retrospective Studies
Risk Factors
Ultrasonography
Ibuprofen
Indomethacin
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