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Results for “Intestinal Perforation”

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At least 163 records · Page 9Linked to original sources
PubMed1989

Idiopathic intestinal perforations in the newborn: an increasingly common entity.

Between 1982 and 1987 seven neonates ranging in age from 24 hours to 1 week were treated for idiopathic intestinal perforations at the Montefiore Medical Center, Albert Einstein College of Medicine. Four of the infants were born prematurely; three were full term. Five were being treated in an intensive care nursery when the perforation was diagnosed. All infants whose perforations were due to necrotizing enterocolitis, appendicitis, Hirschsprung's disease, meconium ileus, intestinal atresias, or drug therapy are excluded from the series. None of the infants had associated anomalies. The sites of the perforations were as follows: two in the jejunum, two in the ileum, one in the cecum, and two in the transverse colon. Six of the perforations were on the antimesenteric aspect of the bowel; one was on the mesenteric aspect. The sizes of the perforations ranged from pinhole to 1 cm in diameter. All the infants did well. Pathologic examination of the resected specimens failed to reveal an etiology for the perforations. There were no cases of duplication or muscular hypoplasia. We believe the etiology of this condition may be ischemic necrosis, secondary to a localized vascular accident in the wall of the affected viscus, but we do not have a good explanation for the upsurge in cases we are seeing.

Colonic Diseases↗
PubMed2005

Postoperative outcomes of extremely low birth-weight infants with necrotizing enterocolitis or isolated intestinal perforation: a prospective cohort study by the NICHD Neonatal Research Network.

OBJECTIVE: Purposes of this study were: 1) to compare mortality and postoperative morbidities (intra-abdominal abscess, wound dehiscence, and intestinal stricture) in extremely low birth weight (ELBW) infants who underwent initial laparotomy or drainage for necrotizing enterocolitis (NEC) or isolated intestinal perforation (IP); 2) to determine the ability to distinguish NEC from IP preoperatively and the importance of this distinction on outcome measures; and 3) to evaluate the association between extent of intestinal disease determined at operation and outcome measures. BACKGROUND: ELBW infants who undergo operation for NEC or IP have a postoperative, in-hospital mortality rate of approximately 50%. Whether to perform laparotomy or drainage initially is controversial. Also unknown is the importance of distinguishing NEC from IP and the current ability to make this distinction based on objective data available prior to operation. METHODS: A prospective, multicenter cohort study of 156 ELBW infants at 16 neonatal intensive care units (NICU) within the NICHD Neonatal Research Network. RESULTS: Among the 156 enrolled infants, 80 underwent initial peritoneal drainage and 76 initial laparotomy. Mortality rate was 49% (76 of 156). Ninety-six patients had a preoperative diagnosis of NEC and 60 had presumed IP. There was a high level of agreement between the presumed preoperative diagnosis and intraoperative diagnosis in patients undergoing initial laparotomy (kappa = 0.85). The relative risk for death with a preoperative diagnosis of NEC (versus IP) was 1.4 (95% confidence interval, 0.99-2.1, P = 0.052). The overall incidence of postoperative intestinal stricture was 10.3%, wound dehiscence 4.4%, and intra-abdominal abscess 5.8%, and did not significantly differ between groups undergoing initial laparotomy versus initial drainage. CONCLUSIONS: Survival to hospital discharge after operation for NEC or IP in ELBW neonates remains poor (51%). Patients with a preoperative diagnosis of NEC have a relative risk for death of 1.4 compared with those with a preoperative diagnosis of IP. A distinction can be made preoperatively between NEC and IP based on abdominal radiographic findings and the patient's age at operation. Future randomized trials that compare laparotomy versus drainage would likely benefit from stratification of treatment assignment based on preoperative diagnosis.

Drainage↗
PubMed1998

Spontaneous intestinal perforation in premature infants: a distinct clinical entity associated with systemic candidiasis.

PURPOSE: The aim of this study was to define patient characteristics, risk factors, microbiology, and outcome of spontaneous intestinal perforations (SIP) in premature infants. METHODS: To identify the characteristics and frequency of SIP, the medical records of 94 premature infants were reviewed retrospectively. RESULTS: Eleven infants experienced 12 episodes of SIP and 53 infants had 55 episodes of confirmed necrotizing enterocolitis (NEC). Compared with infants who had NEC, the infants with SIP were smaller and born more prematurely. The onset of illness was earlier and was associated with antecedent hypotension, leukocytosis, and a gasless appearance on abdominal radiograph. Blue abdominal discoloration was present in 11 of 12 babies with SIP, but in only one of the babies with NEC. Infants with SIP were significantly more likely to have systemic candidiasis. When controlling for birth weight and age, early onset, blue abdomen, and a gasless abdominal radiograph continued to be statistically significant markers of SIP. CONCLUSIONS: SIP occurs about 12-fold less frequently than NEC in preterm infants. A combination of clinical, laboratory, and radiological features distinguish very low birthweight infants with SIP from those with NEC. Obvious signs of bowel perforation are infrequent with SIP. SIP is frequently associated with systemic candidiasis.

Candidiasis↗
PubMed1990

Renal excretion of enteral gastrografin in the absence of free intestinal perforation.

The renal excretion of orally administered water-soluble contrast medium has been described in intestinal perforation (Mori and Barret, 1962). We present a case in which orally administered Diatrizoate methylglucamine (Gastrografin, Schering) was detected in the renal collecting system on computed tomography in a man with an ischaemic segment of small bowel associated with abscess formation but no evidence of intra-peritoneal perforation.

Adult↗
PubMed1979

Antenatal intestinal perforation and meconium peritonitis associated with the neonatal small left colon syndrome.

Although NSLCS has been considered to have a benign course, we have described an infant who had intrauterine intestinal perforation and meconium peritonitis associated with the NSLCS. Infants of diabetic mothers who are stillborn or who develop abdominal distention shortly after delivery should be suspected of having this complication of NSLCS. This disorder must also be considered in the differential diagnosis of infants who present with meconium peritonitis.

Colonic Diseases↗
PubMed2006

Laparotomy versus peritoneal drainage for necrotizing enterocolitis or isolated intestinal perforation in extremely low birth weight infants: outcomes through 18 months adjusted age.

OBJECTIVE: Extremely low birth weight (ELBW; < or =1000 g) infants with necrotizing enterocolitis (NEC) or isolated intestinal perforation (IP) are treated surgically with either initial laparotomy or peritoneal drain placement. The only published data comparing these therapies are from small, retrospective, single-center studies that do not address outcomes beyond nursery discharge. The objective of this study was to conduct a prospective, multicenter, observational study to (1) develop a hypothesis about the relative effect of these 2 therapies on risk-adjusted outcomes through 18 to 22 months in ELBW infants and (2) to obtain data that would be useful in designing and conducting a successful trial of this hypothesis. METHODS: A prospective, cohort study was conducted at 16 clinical centers within the National Institute of Child Health and Human Development Neonatal Research Network. To assist in risk adjustment, the attending pediatric surgeon recorded the preoperative diagnosis and intraoperative diagnosis and identified infants who were considered to be too ill for laparotomy. Predefined measures of short- and longer-term outcome included (1) either predischarge death or prolonged parenteral nutrition (>85 days) after enrollment and (2) either death or neurodevelopmental impairment on a standardized examination at 18 to 22 months' adjusted age. RESULTS: Severe NEC or IP occurred in 156 (5.2%) of 2987 ELBW infants; 80 were treated with initial drainage, and 76 were treated with initial laparotomy. By 18 to 22 months, 78 (50%) had died; 112 (72%) had died or were shown to be impaired. Outcome was worse in the subgroup with NEC. Laparotomy was never performed in 76% (28 of 36) of drain-treated survivors. CONCLUSIONS: Drainage was commonly used, and outcome was poor. Our findings, particularly the risk-adjusted odds ratio favoring laparotomy for death or impairment, indicate the need for a large, multicenter clinical trial to assess the effect of the initial surgical therapy on outcome at > or =18 months.

Child Development↗
PubMed1981

The effect of experimentally induced intestinal perforation at an early developmental stage.

In chick embryos we studied the effect on intestinal development of an experimentally induced perforation and a vascular lesion performed at an early developmental stage. The results show that an intestinal perforation will heal, but may lead to intestinal atresia with microscopic signs of meconium peritonitis. Conversely, a vascular lesion induced at an early stage of development does not lead to intestinal atresia, while a vascular lesion performed at a late stage of development does result in intestinal atresia, but without any signs of meconium peritonitis.

Animals↗
PubMedDate not supplied

[Intestinal perforation after treatment of radiation cystitis using the neodymium:YAG laser].

Female patient with multiple episodes of pelvic surgery and with radical cystopathy, treated by Neodymium: YAG laser photocoagulation with haemostatic purposes. During the post-operative she developed intestinal perforation with fatal evolution. The cases described on this serious and infrequent complication of laser endovesical application are reviewed, commenting the technical and anatomical elements that justify it.

Cobalt Radioisotopes↗