Neonatal Gastrointestinal Perforation

(1)

= Abstract =

Neonatal Gastrointestinal Perforation

Seong-Chul Kim, M.D., In- Koo Kim, M.D.

Division of Pediatric Surgery, DepaTlment of Surgery,

UniveTsity of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea

Perforation of the gastrointestinal tract in neonatal period has been associated with a grim prognosi s. Recently there has been some improvement in survival.

To evaluate the remaining pitfalls in management, 19 neonatal gastrointestinal perforation cases from May 1989 to July 1996 were analysed retrospectively.

Seven patients were premature and low birth weight infants. Perforation was most common in the ileum{56.3 % ). Mechanical or functional obstruction distal to the perforation site was identified in 7 cases; Hirschsprung's disea se 3, small bowel atresia 3, and anorectal malformation 1. These lesions were often not di- agnosed until operation. Five cases of necrotizing enterocolitis and 1 of muscular

defect were the other causes of perforation. In six cases, the cause of the perfo- ration was not identified. Perinatal ischemic episodes were associated in five cases. Overall mortality was 15.1 %. Becau se a considerable number of gastrointestinal perforations resulted from distal obstruction, pediatric surgeon

should be alert for early identification and intervention of gastrointestinal ob- struction, particularly in patients that are premature and have a history of is- chemia.

Index Words: Neonate, Gastrointestinal Perforation

Ai

{l),~o}

.<fVJ-¥tt1-% oJ]

^9.^] ~ *"-f~

;: -

^.^:U^]^{l ^B-il}

T~~~ ¥r2-], o}~], -8J-A~::z.l] ~ 9.] ^~.!f-{l ^~-W-oj] ^£

~Ti5} Jl, 0}-"'1 £ 20

%

Ll1::z] 40

%

9.]

if.g.

^A}DJ^-£-

%

^{.5!. '()}^q.

:4 ⁷ ^-1

^oj]^~^$1::<J-^{!

9.1 gj1

S:ll

""a

t)ij

'i:! 01 9-

^~

'() 0]

'Zi.Q.

L-j-, ~] -2-oJ]-c

il l

A }A,n)-~ oj] 9.m oj]7} 7 }::<J- fio] .5!.Jls=.] ^Jl

914.

0] oj] Al;:<}%o]

':3

^~^{~ {l),~}^o}

oJ

::<]-,,1 ^-71_.:;:L ₀₁ _.$J01 ⁰¹ ),j-A]-i!} <'>1] "8"_~ ~A}"61 M .:'<-1

-r Ci t! -"'2 ^{0 -} t2 ^L..:. ^, ^P ⁰ ⁰ ^, ^-, ^-2 ^_^{.... -} r ... 1 , "L-

-%9.] ujpolJi!} oj]J7oj] £%0] 5'1 Jl::z.} ~ 'ClT~ {l"6~

i5}9Jq.

- 41 -

(2)

1989\:3.

5~Jf-E1

1996\:3.

7~ 7J}/Z]9i 7Jzl- %~

~.lil~oj] "'l W<JB-~-%.Q..£ 'T~~t {!.Ago]~

19

~o]~.2..oj,

0]%9.1

9i.!f-71~%

!2.1:11.£

~t>J~ c;j=jl-

~ ~"5~"6}

5::l, cj-.

19 ~

9.1

~0}'15'-

'f}0 }

7} 15 ~, a:j

° ^}

^7}

⁴

^~^0]^~

^cj-.

° ¹ ^% ^9.1

^~.Ag

^j,i] ^'15'- ^JJj-

^~H

^Ell

^7]

^Z!- ^9-l ^% ^OJ

^~.g- ^{z} z}} ^3.

2kg(1.0-4.4 kg), 389-(27-439-)01~cj-.

7oj](36.

8 % ) 9.1

:A

J

~ ~o] p] ~o}o] ~ A

1

1-1 %.Ag ~1]

'15'-0 }oj]).l

~.Agi5}5::l,~tl]' 4oj]~

JJ1 AtAd AJ<fJ, 1

oj]~ ~AJ9-l

-c

.£;%

:@.~oj] 9i~ ~-%.2..'£ .A

g Z}£1 oj ,

2oj]~ 5:AJ 9-l !f:!,()~~9i ~i5-0]~q.

~ AJB- Jf-~~ ~.A~ Jtls:.~ ~ :AJJf-7} 9oj](56

.3

%).£ 7\-

:A

J

.~~.Q.V\,

t:\jAJ 4"1]'

~

3"11. -%:AJ 2

oj], -3J

AJ 1 oj] 9.1 -i? ° m ^cj-.

ti

^~^~^~

^{Jf- 1l1]} Sll ^Ad

^~

^{l(! 0]} ^'U

^~

^1i:l. oj]7} 7 oj].£

Hirschsprung~l

'1l 3oj], 5:AJ.!f--%%

3oj](2oj]~

Ell

l(! Ad

*

10!}

<fJ ),

/Z

-j

~

138 9.1

"8"J~ -3J AJ _• 7

]138

1

oj] % ° m ^{cj- .}

1!l] SlVd

~ l(! 0]

\d

^~

1i'i

^oj]~ ¹²

^oj].£

^).-j, ^~^'()

^0] Ef

•

^Unknown^causes

•

^NEe

•

Muscle defect

*

^Atresia

4 A ^H-Dis.

• t

^ARM

Fig. 1. Sites of perforation(NEC; necrotizing enterocolitis, H-Dis.; Hirschsprung's disease, ARM; anorectal malformation)

~i5}/Z] U~1i'i

7J

^~7}

⁶ ^ojj( ² ^oj]

^~

Elll(!Ad *1O!}'j!j) , JJ1

'+'d AJ<fJ

0] 5oj].£

t:JlJf-~%

;'t}/Z] o

}):1cj-.

!f:! '() 0]

Ef~i5}/Z] U~1i'i

2oj]9.J- j!-PVdAJ<fJoj]

9i~ ~-%

3

oj] ojjA1 ~

'?:l {Vd

^Jl^~

'?J- , ^oJ

^10!} ^5:^7]^TI}^{~, ~}^%~

\':l-

~, %~B- 7H ~~% ~~

'()s:.PJ]E}{!9i A}-§- % ^9-

~7]9i "6f~H~ l(!9}~

OJ:7]W 'T

^'U~^~^~

0]

'U~cj-.

!f:! '()

1;l. ~

JJj-

~

-% Jf-

~

9.1

~ ~ ~ .:::I

1:1

¹

^JJj-

~

q .

% ^{19 oj]} ^'15'- 12ojj(63.2%)

7} .Ag~ 5'?,!0]LjJoj] ~

-% ° ¹

^~

^.Ag-"'

^}

5::l, cj-.

~"61

!f:!

~

Jf- 1111 i:ll ^Ad

~

l(! 01 'U

~

1i:l. 7oj]ojjA1

~

:2.9- 5'?,! o]LjJoj], JJ1 AtAd :AJ<fJoj]

9i~

~ -%.g-

:2. 9-

^).~^~

⁵ ^'?,! ° ]

^~

^oj]

^~^~

° ]

^~^).^~

i5} 5::l, cj-

(.:::I

1:1 ^{2). !f:!}

^~

^Jf- ¹¹¹¹ ^{±117} 'U}

^~

^1i:l. ^{7 oj]} '15'-

Hirschsp·

rung~] ~

2oj],

5:AJlf-~% 1oj],

iZ H-l

^~

^9.1

^t>J~~

AJ7]

~

1 oj] oj]).l

~

1l1] Sll ^Ad

^~

^{l(! 0]}

^{l^~^£1

⁷

^] ^~

^oj]

^~

-%0

]

~.Agi5}):1cj-. Hirschsprung~l ~ 1oj]ojH~

'T~oj11°J AH~oj] ~-%o] ~.Agi5}):1cj-.

JJ1 AtAd:AJ<fJ 5oj]-E

A

J<fJ9i

~AJ~~ ~, Z}Z}

0,

4,

5, 6,

7~

~oj] 4'-~0] "'] "5~

£1

~

cj-.

5:AJ

lf-i5-% 3"1] Of..

1)% 2"11~ ~~~~oj]"'l

"Ell

1~Fd*1O!}<fJ.2...£ ~ ~¥l. oj]

0] oj,

~

all

^3.g-

%-.Ag ",] Jf-

E~ *.!f-~'1JJj-

T!2.7}

'U~.Q.oj, .Ag~ 4'?,!~nojl ~

No. of cases

14 12 10 8 6

4

2 0

0 5 10

o Muscle defect

. ARM

• Atresia

• H-Dis.

• Unknown causes

• NEG

•

\ ^\

-'---'

15 40 45

Age of perforation( days)

Fig. 2. Postnatal age of gastrointestinal perf ora- tion(ARM; anorectal malformation, H-Dis.; Hir- schsprung's disease, NEC; necrotizing enterocolitis)

- 42-

(3)

Table 1. Gastrointestinal Perforation with Distal Obstruction Sex/ Birth wt. Age (days ) of Underlying

G.age (wks ) (kg) perforation disease

---~---~~--

M/ 38 3.5 0 J.atresia

F

/ 39 3.7 0 1.atresia

M/ 40 3.4 5 Latresia

Site of perforation

• •

Jejunum ileum ileum

Operation R&A

R&A R&A

Prognosis

leakage 1

2 3 4

5

M/ 39 M/ 40

3.4 3.6

5 4

H-dis. (R) sigmoid colostomy

primary closure ->colostomy

H-dis.(R) cecum

6 _M/ ₃₉ 3.4 4 H-dis.(DC) cecum primary closure

->colostomy

7 M/ 40 3.2 3 ARM

(low type ) rectum primary clpsure expired Abbreviations: G.; gestational, J.; jejunal, 1.; ileal, R& A; r esection and anastomosis, H- dis.;

Hirschsprung's disease, R; rectum, DC; descending colon, ARM; anorectal malformation

~.Q.5!.. ~~5:1e>1 5~'?(~ "'1~~~ "T-~~:ti}.J- 7.::l~o1

~~li:!

<>l 1 0 1 r:t . 3<>l 1 .2. ¥ oJ1 - "1

D~tl-..!f-oJ]

; t-i-t° 1 9}

~.Q.o:j, ;tl.:g--¥-~ ~lJj] D~tl--¥-

AJ7. 11

^~^li±li±~~o¹

"'1~~5:1~.Q.o:j,

l oJ 1 oJ]" 1

~~-¥- T~o1 ~~ 5:1 e>1 ~

~ 5~'?(~ on 7.H~~01 "1 ~~5:19J.r:t .

Hi rsc h sp run g-"' 1

^~oJl .9.1~ t!~.g.

3oJ]Ol 1)7}

9}9J.r:t . %?11

^4~

61 AJ- 9.1 Hir schsp rung-"' 1

^~.Q.5!..

~ li±~.g. ~,

7,il.AJ-if-3':}.d

^~o¹

exPel B ';:)- -'H

^~

oJ1 s-

7,il.

AJ- 9.1 ;tl

^~^oj^]

9.1

^~

.Jl.

^'i'il.^Jlj-

*

^~

A}-=l-%}. J- 0 1 9J.

^~.Q.

o:j ,

S-~AJ-if-3':"d~o1 "1~~£1<:d,q.

%?11 59.} 6.g.

*7J-1...J1 %c.1717.1] 7}

^{~e>1 g} ^B- ^7R ^*~^7,il.:i!} ^D~AJ-9.1

;tl.:g-01

^~e>1 ^,

;tl.:g--¥-9.1

%~AJ.1t17a"}9.}

°.lA

^*~~

% '" 1

^~~

is-}9;l..Q. ^y.,

"T-~ ~

7l14i'-

^{~ ~}

tlR ttl. 7 1 ^-'5- 9.1 AJ-°R

~

.!i!.

^O:j

rB::g-3': ^0,3

^~^5!..

H ir sc h spr u n g-"'1

^~

9.1 0 1

^~~

-¥--'f1

^~^~~~7,il.AJ-ij'-~

3':"'d o}9;l.c }.

Al-'f1

"6"J-~

61 A J- 7 1

^t§^oj^]

9.1

^~

t!.:g- s:. 1 oJ 1 01

¹⁾ ^~

~q . Zl-0}~ ~}.~~ ~ ~ o} 97,.Q.y.,

tlHttl. %

^~^Jti^£

o}?1 J;-iS-}9;l..Jl.,

}.~~ 2°J'?(H -¥- El~ *-¥-ll~~, -=r-:£,

71li'1 (lethargy) %% sL9;l..Q. o:j, 3

^'!J'?(~

1...J1

^~"'¹

oJ1::::

* 7 J-Lj-j

^,^(h'^-1 ⁷^]7.n~

illl'€l."d

^~^9.1

0J}.J-% .!i!. 9;l.r:t. "6"J-

Table 2. Gastrointestinal Perforation of Unknown Causes Sex/

G.age(wks)

Birth wt. Perinatal (kg ) history

Age (days) of perforation

Site of

perforation Operation Prognosis 8

9

10 11 12 13 14*

M/ 40 3.9

M/ 38 3.1

M/ 43 4.4

M/ 27 1.1

F/ 34 1.9 F / 37 3.2

twin, PROM, RDS, PDA

F / 28 1.0 PIH, RDS

4

6

4 7

o

______________________ ^.~^P^~^D^~^A^~,~^I^_^V^~^F,^~^t~^~,ⁱ^~ⁿ^~______ 4 _ Abbreviations: PROM; premature rupture of membrane,

PDA; patent ductus arteriosus, R & A ; resection & anastomosis,

*Muscular defect of the perforation site was suspected.

- 43 -

stomach

stomach stomach

• •

ileum ileum ileum

wedge

resection wedge.

resectlOn wedge.

resectlOn R & A

expired expired

ileostomy E- C fistula R&A

R&A mesenteric hernia

~ _ _ _ _ _ _ _ _ _____ _ _ _ _ _ _ =:..0=" - - - _

RDS ; respiratory distress syndrome, IVF ; in vitro fertilization,

E- C;enterocutaneous

(4)

Table 3. Gastrointestinal Perforation with Necrotizing Enterocolitis Sex/ Birth wt. Perinatal Age(days) of Site of

Operation Prognosis G.age(wks ) (kg ) history perforation perforation

15 M/ 32 1.6 twin

16 M/ 33 1.7 IVF, triplet

17 M/39 3.0 TGA

18 M/30 1.5 RDS, PDA

19 M/ 27 1.0 PROM, RDS

Abbreviations: SBS; short bowel syndrome,

12 cecum R&ileostomy

9 7 13

44

&SB ileum ileum ileum ileum

R&ileostomy R&ileostomy R&A

R&ileostomy IVF; in vitro fertilization,

SBS

TG A; transposi tion of great arteries, RDS; respiratory distress syndrome,

PROM; premature rupture of membrane, SB ; small bowel

PDA; patent ductus arteriosus, R & A; resection and anastomosis,

-It-.g.

~J'.g. ~~£. 3i~ 'V-~jl, ~%

18-o}a:j

"Ejj~%

~~~

'T' 'V- oj, <3"J-lt-oJ]

~7n ~ 7}"6"}~

q.

'T'~~

;;'l;;']oJ]so.

~T"6"}jl JIll~-"a ~91 ~~.g.

.!i!.O]A] ?J"

'XlJl,

7~~o}a:j

:ti'%¥! ?4:AJ91

t!-e%~:il} ~7Jt.l1

Al].3:1%

o}~~y., ~~

6"']:z!'i!oJ]

",}uJ"6"}~q.

.!fd «10] -'f

~ "6"}A] ?J"~

Ii:! 601] 01 2) '3'- 301]

^oj]

"'i-c

~ ~1]-¥-91

r11 'i!-¥-oJ] :ti '% 0] 'V-

~~

oj,

'T'~ ~

r11 A Fa

~~o] -"il<'i}~'i:!

Z01]-c

A}UJO}~q

.

^.:L

9.], Z01]-c

~-"~ ~

91 A}i'"t.l1 §VJ:ti '%

~£. -"~

z{ 501 oj,

~

all 11 .g.

£7]oJ~TI}<g1£. ~{l

279-oJ]

~'i!¥!

:@-o}£.,

^.Q.

%~~~o] 'V-~Jl, ~so.uJ]E.}{lo] ~a:j501~~oj, -"~

~ 7~~noJ]

,%:AJ9.l :ti'%o]

'&-"~~

O1]o ]q.

~al]

1401

2)-c ~{l-"a jl~~, ~%~~~o]

%J?l501~jl, %~~7~~~~£.

«1so.uJ]E.}{l0]

~a:j

-'B,

~-"~~]'3'-

1.0 kg91 :@-o}£,

-"~~ 4~~noJ] ~-¥

ll,!l'i!:l!}

~7Jt.l1 %2.17]~1]7} ,&-"~"6"}~q. 'T~s:7,:h}

§j:AJ

~t!-¥-oJ]

?4 7cl 7 mm 91 :AJ

S!j

0] 0}9-

~J'

jl

~ ~

~ tM~o] 'V-~~oj, ^.:L

'3'-°JoJ] 2 mm91 :ti'%o] 'V-

~Jl,

tMc.J s:7,1-"J t.l1%-'-J-2-:l!} 9.]%9--2-91

~-eo]

~~-'B

O1]o]q.

.JI1AFa

:AJ~oJ] 91~ ::B'%~

501] 01 3)7}

'V-~-c

(1],

.£.:'f-

-"~~ 5~ o]~oj]

::B'%o]

,&-"~"6"}~jl,

401]

-c

^p]~o}o

]1i:! J..i Ai

^~-"~^~^1]'3'-0}~

^{q. 301]}

^oj]

^J..i-c

^~

AJ~91 <5l ~-"a ~:§}~

3':211t"}-c

{i?;~ ~:@-o] 'V-~~

oj, y.

oj

A] 201]

^oj]

J.. i so.

^~]r:Jl

%

^~

91 1f-t!-o]

^J..]?;~

501

^~

~q. 311J..Fa AJ~oJ] 91~

::B'%01]oJ]J..i91 A }U J.g. \:d

~q.

{l}.~

o} .!f1 AJ-t!-::B ,%.g. 1939 \'! Thelander

¹

7} 85 O1]oJ]J..i 99%91 J..}uJ%%

.!i!.Jl~

0]4-,

~-'-J-'-J:l!}

01]

4-oJ] 'V-oj 1'J".g.

~:§}7} 'V-~q. ~{i {l}.~o} tM"Ejj}.~

c.J 91 0 ]

~, 'T'~'T'

7], 'T' ^<?!lk

^~,

'T'

^~

, ^7cl78

^~

^Cd ^oJ

~, <3"J}.~A1]' ~~ k~

%91

~~oJ]

rrJ-2f .!i!.q 1'J".g.

01]7} .!i!.jl501

~jl,

O1]4-so. <3"J-'-J501

~q2. Ef.~

1'J".g.

p]~oF~'O] }.~~"6"}71]5011i:!J..i, .JI1J..FaAJ~O]

7}AJ

^~

~ .!fd~~£.

r11:'f-501 Jl 'V-Jl,

~AJ~::B,%

:@-0}91 y.

0]-'4 ;(1] '3'-0 ]

~

S:

<'i}

jl 'V-

~

oj, ::B '% 91 .!f1;;'] s:. .!i!. q.

.!fd~-¥-£

o]% "6" }::: 0J-'-J% .!i!.«1q3.

{l}.~

o}

^~

AJ -t!-::B '% 91 .!fd «12 -

⁹^~£.

:l!} 71 oJ]-c .!f1 AJ

~91

lll]Sll.7 } 9-£

71~501 ~~y., ~-2-oJ]-c

.!i!.q {l

4;=-~ ~t!J!j-

;;']lioJ] 91%n

.!f1:AJ~lll]S11oJ] 91~:ti'%

.g.

~S:"6"}jl, -'-Jr1131~£.

.JI1J..}-"a

AJ~

o]y., AJ91

<5l

~-"a ~§}~

3':211t"}-c

~:@-oJ] 9.]~}

l:l]%o]

~7}<'i}

Jl 'V-q . .!i!.Jl2-4. 6oJ] 91 o}1i:! .JI1J..}-"a

^AJ~

0] r117n 40

% t.l1 A ] 70%, 7]7-1]31 Ef.-i=- 7]*31 AJiI1 ]S117} 15%

t.l1A]

20%~ ;;'}A]~q.

A1A}%91 O1]oJ]J..i-i=- 701]

(36.8%)7}

~AJ~lll]SlloJ] 91~ ::B'%o]~~oj,

0]'3'-- 501]-c

~}.g4-91 ~t!:l!}78'3'-oJ]

::B'%o]

'&-"~~

01]£., .!i!.q

uu}~ ~t!:l!}

;;' ]li7}

°FF-oj~q1i:!

::B'%%

~

'T'

'V-~~c.J2f -,,~z{¥!q .

~

'& -"a .!f1 AJ

~::B

'% so. 1'J".g. 01]7} .!i!.Jl501 jl 'V- -C

(1],

Zamir %l0.g. :; '&-"a

.!f1AJ~::B"6 ~, .JI1J..FaAJ~

g

J..]J..}"6"}-c ~-'-J-'-Jo]y. llJJ..}{i~31

s:7,1% .!i!.O]A] ?J"

- 44-

(5)

.Q. nj,

y~ i::

::;Y'J 3J 73 01 1 111m

^1:1) ~,

B-

^~-

Ad 9.1

~

-=s % 5!.-

^a

1 nj, -?!f-l 3':: 3J 9. 1 :iLl A} 7 } 7 19.1

~.:il

, 7' J-'¥-

-=S'6-% S1 71111

^~

7'JlEjl111 Y-

^71-'l5-~

7'JlEjl111 7}

^~-l::-

<=>11£ :AaS101-sctq. Tibboel%\?:-

Ell~A<l*12.f~S1

50 %7 /-

~~Ad{)~oj) 9-/~ ~~£ It.ILo/-'X1.r:}.

r-Hlf'-

l'i!-01

_l.!.. _~E-loI1-A1;7,~=£-_--, _'2. ₀ _'L.:. _{0 '--}

01/,1?

_tJ _L.: _{U ,} ^~A171₁ _L! ,...L '--

IX-'='- A1A110171

L.:. 0 r

*2-] ~

12.f%,

^jjl~y~

%,

^E~

0]' Y-

^{)A~

O}oj]),i

^A1^~

i::'6-%

3::21l-5}~ AJ~oJ1A1,

Jll-j-

{VJ~£9.1 ~fi-7~

A~£-_1...; _2. ₁₁

01"i5

^li_n

7'1-7}01-"&lTf2 -'='-

₀ e..., e '-

7

^p

1-/_

^-l...:.

-0 -1

r....1-'-,

-;] 2'!c:;L.-Jl-'='- 7'1-01 2..., ... ,

^L 0"::---'

:iljA}-'4

^~

-=Sol

^{~A~ ~q}⁷¹⁰^- ¹²^. AlA} ^~.91

oj] oJl Ai SO

5 oj/ 7 }- {)

^/.2J

01-91 A1 <}S:.%J4 ?liCl 0)

^~

^'Xl,

^e}-.

el!f-l ¥J-oJl

.91"i5~

Ai SO $-j 7-J-:t!-.91

~

-=so 1 0]:71

~

Y

~-c- tI}, Bell'~

60<=>1]%- 6ojl,

Buchheit% 5~

510jl

%- 9 ojl

~

5!.-.:il-5} sct q .

!f-l;g-~

.:tl

^~9-J ^.1..]7)^c- ^A~^~

5

^~

oj) Ai 10

^~

0]l.Jl oj)

J:11J:j!-~0]

Y-s}\:l:-q. 2-59.

~ol

$-j7-J-¥J-lEjlIIIoj]

S1~ ~

~..g.

ltr:}

~~cj ~A~i5}c[l],

Bell'..g. $-j7-J-:t!-lEj]llloj]

S1

~ ~

-=s..g. 5.'...!f- 5

~

01 LJ1 oj]

~ A~

-5 } sct L}.:il -5}'lJ.. q. .

0/ "1/ 1;'}-i5/-cq,

.:D(A{--"d

;g-?N)

~1

tt - ti

^*,§-

^J:/-S:.

^~-"!)

~A~-5}-l::-[ll,

Buchheit% 5..g.

JJ.]J'Vcl7-J-~oJ] S1~

t!

-=S-"]7]c llan-

^14~0]nj,~-:Z:--"d

W'J{!

~-=s..g.

lla

n- ⁹

^~

^oJl

^~A~

^-5}sct ^q.:il .Jt.:il-5}sct q. Al7-}%.91 oj] oj]

"'1 SO !f-l;g- -tl: JIll Sll ^oj/ 9-J

^{~ ~}^-:g.~

^S'.:!f- ⁵

^~^a

I L/l oj]

~

A~

o}O:j

^tll~~

OJAJ-% .Jtsctq.

!f-l7-J-{!~-=SA].91

%.J..J .Q.£-e *-'fll§

^~'6⁹

0 ] 7}7'J

~i5}nj, loIJA}{l~?4 i::7,:!.Q.~-l::-

71*34 61001 65%

tHA)

85%oj)A1 L}-E}'r!r:}. Steves

^'3

E1

^li:iloJ)

91 ^0/-

~, 71~% ]t~

%o}%- 13%-l::- $-j7-J¥J-

~-=S01 ~

~~P1, °1~ r.J1-'f~~ ~-=S~%71-'4 ¥J-~o] ~~

q.

^.::lcl~

.. ^{£ %0}.91}

^~JAJ-^~

i:: ::;j:ilj- loIJ A }

~ ~

i:: 7,"1 .91

%-~o] ~Ro}nj,

7]*0 ]

~Aw

uJ1oj]-c-

~0}.91

~AJ-AJ-, ~-=S~%71 %-,¥-, *J:j!-~A}

i::7,:!, 71t- oly- pneumomediastinum.91 *.!f. ^%%

.:il?;j-5l10~ ~qI3.

/<lA}%.91 <=>11 oJl Ai-l::- 190jl %- 11 oj]( 57.9 %) oj] A1 71*

0) -tl:~sj ~

r:}.

~-=s~ ~n}oJjA1

7}7'J- \.'i'01

~A~-5}D1 2, ',U, 01~

¥J-o 1

~

%% '5!

^~

^{l-5}.:il

^~

^q..

^A1A}%

^{S1 ojl} ^{oJl Ai SO}

19 oj] %- 9 oj] ( 47.4 % ) 7} :§VJ-6J/ A1::B -=s

^a

1

~ A~

i5} sct r:}.

{)A~

0 )- !f-] ?l-¥J-::B-=SS1

^y~ ^2,^{" 0}

2-

^~0}S1

AJEll 7}

OJ

~ ~ Ltjj

on -l::- :B

-=S-'f~ ~ ~~

:ilj A}-'f :AJ 711-'4 td

B-lI:- -'f} 0] 4't!£].:il

~q .

-5 } 7.]oJ

~0}S1

AJEll7}

~

~:Aa"6}71L} , ~-=S-'f!f-]7} ~VJ-oll-j- ~7-J,()

<=>11oJ]A1 -l::-

7'~20/ _o _T _- _:...L.

7--"

₀

10)

~;7..Jr:l-;] _,\...:._...r.t 01.-14,1 0

E-i5) JJ.)A)--"17'l-0:l

....L- M '-T . -, 0 0 tJ'

S1 73if- 14 15 :iljA}J:j!-S1

:Aa~~

73ll17}

~~qJ

o}O:j -lI:-

~-'f9.]

-'f-%o]

^~A~~

y ?l.:il,

^x~^~~~

:AJ;Al1

^~

S1

~

5!.-

~

$-j"i5n

~~ ~ 7,J a

1

~

7-J ;All

~

uJ1 oJl-l::- :Aa AJ

7-J-.91 E'-{J%

^°t7]~

Y

^9J.Q.E-~

7-J--'f-S1 3'::-"d o]

1:-)

* 7J3'::£].:il ?lq.

A1A}%SO ~0}.91

AJ-Ell-'4 T-id::

7,"1oJl rt}2-J-

BB~~-5}71l-j-, 7'J-f~

S-A.3-5}sctq. td

~-lI:-~

7 <=>11%- 1 <=>11 oj] Al

-lI:-~J:j!-~%01 ~A~

o}sct.Q.nj,

3<:>//oj)J,.i c- 3:!Y~-"/ ;g-3f-~ 3'::~01-'X1..IL, 2

oj)

oj) ^k)C-

~7JA11.3i:ilj- lln'2lj~% Al<5~~ ~ 2:7.}y~Al 7-J~ -:}

~Aclo}sctq. {)A~O}

$-j7'J-¥J-:B-%..g. HirschsprungMl

~oJ]

S1"i5n A1SO

0]:71~

4-

~-c

e}16,

7-J-~-=S( ~<51

r11;g-).91

~'()% ~7,:!o}7.]

*-5}O:j 7-J-Zl-12.f

^~ff-7-Jon

y.

~~A.3~£ A~zj-~ ~

73if-l-j-,

A}~11 ~'6-% %Jt}

O}A] ?)~ %Y~7]~-=S.91

<=>1] oj] Al-l::-,

~4-%71-'4 ~

1t-'f.91

%~7'Jli17cJA}y- 4-~~2.1 Al1od~

¥J-%JJ.} r.J1

1rs-~~ ':J,] ~?PJliJI~ ~"i5J) o)~ ~~-5}-e:jo): ~

~

01q..

ojl-f--l::- Thelander

^l

7} 99%

9.] ..

q0J-%% It.:il

^~

°1~, T€-~ ~~%

5!.-O:j ,tl-2:oJl-l::- 20% LJ1 7.1 40

%

2

^' ^- ⁶ ^{BIO 17}

9-J ^A}0J-%

^~^It^~^q. ^A1A}%S1

^oj] ^ojjAi.£

13.5%S1 A}OJ%% ]tsctq . St-Vil%6..g.

~ol

i::7'J-

~-l-=S

oj/ oj]

Al-~/

oj]

^V-7} ~/<l

i5]

'f0}~ q.IL -5}'X1..IL,

1'ibboel%s..g. 7]*01

91.Q.~ ~Bol ~!fr'2-l

ol-'f-o-jhj

q)-f-f,. r:-) ~r:}:il

i5)-'X1.r:} . oj)-f-oj)

OJw:~

vP)-c-

^~

7.}

£ -l::-

~o

}9.1

~11

%-,

~

-=s 9.1 -'tl. '()

^~

-'f!f-l, pH, y

~17};;Z].91

73:ilj-Aj{} %0]

71~£j.IL

9Jr:}.

i5}A]~

7}

?,f

%-

Jl ~

3l.

~

.:il $-j

~

-2-

~o

}oJ] A1 7-J

~

-=s

~ ~

:!f-

ClJ]

.!f-.:il, 0]-"-1 oj]loIJ

^~

3'::7]

^~B-%!f-l~ ~-y~

{!

~ Jlj-

S1;;z 12-J-.:il

A~ zj-~

L} .

19qJS1

~o}%-

3qJ

⁰

l A}OJ--5}O:j 15.1 % S1 A}OJ%

~

5!.-sctq.

{)A~O} $-j7'J-¥J-~~..g. ~~o] ¥-~-5};;z1

~71Y-(31.6%), :iljAV.37-J-~oJl S1~

oj](26.3%)7}

m~q.

01 73

~

\.'i'..g. oj]7}

v]

S:;-o } 3:.-c- Al %AJ

~11

%

- 45 -

(6)

o}~.2...vj, %UJ1{J.-7~'l:-~O)y- %c.j ~~'6'-

%0) %!fr

c1..w A] ).~Ol AJ )'~A ~Ol 7 1"=.).1 2. z~-;-) 0101rl -.

-11 '-" 1, ^t...:. ci r ^'^, ^L. ^....l- ⁰ ^~ ro ⁰ ^2. ,,--""-- MM '-T· ~

C1

Ê..i2. ô!^{r;~ ~}ô ^}^~ôj]

A i

^A^J-^{{i -t'-} ^9.¹⁷^}~⁾²

g

^~^.!f-oJl

.!f- oj 0]: "is"} o:j, Ail

'?J.

^{~ ~}^~^{0 )} ^~.B..

W

^?;:! ^.2...^i2. ^A^~

^2f

^~

q.

^{;E~ ~}

-'f1-¥-

^llll^S:l1 ^7} 7 aj]( 36.8

% )

oj]

"'1

^~^{i;~!Xl ~}

q.

^01% ^~^Hirs^c^hsprung^,;.\^l ^~³^aj], J::;AJ-.!j!--t'-%

1aj], Al-'f1~9.j 15"J-~?FJ-71~ 1aj)oJVl1':-, .!i!.q {}4;'-

~ ~B, ~o}9.j o)%~ j,).li.7} o).ifoj ~qt;'1, ;>oJ {i -t'--€:-

:uJw ^T

<j~.9.. c.j

'*

^).~

^2f!Xl

^o:j, ^~^-t'- ^~).~^"'j

oJ).s:. .!i!.

q {}

^4;=-~t ^T~ol

01

^if-oj^~

^% ^?;:! 01 ^q ^.

1. Thelander H: Perforation of gastrointestinal tract of newborn infant. Am J Dis Child 58:371-393, 1939

2. Tan eEL, Kiely EM, Agrawal M, BreretOI1 RJ, Spitz L: Neonatal gastrointestinal perforation. J Pediatr Surg 24: 888-892, 1989 3. Borzotta AP, Groff DB: Gastrointestinal

perlarat'.cm '.0 i.o\aots. Am J Surg 155:

447-452, 1988

4. Bell MJ: Perforation of the gastrointestinal tract and peritonitis in the neonate. Surg Gynecol Obstet 160:20-26, 1985

5. Buchheit JQ, Stewart DL: Clinical com- parisi on of localized intestinal perfora tion and necrotizing enterocolitis in neonates. Pediatr 93: 32-36, 1994

6. St-Vii D, LeBouthillier G, Luks

FI,

^Ben-

soussan AL, Blanchard H, Toussef S: Neo- natal gastrointestinal perforations. J Pediatr Surg 27: 1340-1342, 1992

7. Tibboel D, Gaillard JLJ, Molenaar JC: The importance of mesenteric vascular insuffi- ciency in meconium peritonitis. Human

Pathol 17:411-41 6, 1986

8. Tibboel D, Molenaar JC : Meconium pento· nitis-a retrospective, prognostic analysis of 69 patients. Z Kinderchir 39: 25-28, 1984 9. Weinberg G, Kleinhaus S, Boley SJ: Idio·

pathic intestinal perforations in the new·

boen: an increasing common entity. J Pe·

diatr Surg 24:1007-1008,1989

10. Zamir 0, Goldberg M, Udassin R, Peleg 0, Nissan S, Eyal F: Idiopathic gastrointestinal perforation in the neonate. J Pe- diatr Surg 23: 335-337, 1988

11. Fonkalsrud EW, Ellis DG, Clatworthy HW: Neonatal peritonitis. J Pediatr Surg 1:227-239, 1966

12. Tibboel D, Van Der Kang AWM, Molenaar JC: The effect of experimentally induced intestinal perforation at an early develop- mental stage.

J

Pediatr Surg 16: 1017-

1020, 1981

13. Steves M, Ricketts RR: Pneumoperitoneum in the newborn infant. Am Surgeon 53:

226-230, 1987

14. Boston VE: Necrotizing enterocolitis, in Freeman NV, .Burge DM, Griffiths DM, Malone PSJ(eds): Surgery of the newborn, chapter 18. Edinburgh, Churchill Living- stone, 1994, Pp 237-238

15. 7dod~, o)"l3"l,

7dOdo}:

^-::-i~Vj ^;AJ 1ll1~'6'--27

ajjoJl r.H~ qdAJ-'-'J .Jl~. 91~~:9jAl 31(4):

465-471, 1986

16. 7dAj~, "'i~~,

%-::-i7J, {l'tlT:

^?J{i-t'-%

%

~~ Hirschsprung,;.\) ~ 3aj) .!i!..Jl. J::o}91~

1:186-189,1 995

17 ^zlA-1~ ⁷ ^1:£01 ² ^1?-].2· ^?-]).~o^} 01?0l--lll- ;<~.:rr

• '0 -, t ! - , 0 0 ~, P ^1....:. ^1..-' 1....:. () -r) 1....:. l....!. 0 •

.2.J-4"§:)-:9j :Aj 51(5) :722-727, 1996

- 46 -

Neonatal Gastrointestinal Perforation