Gastrointestinal perforation and peritonitis in infants and children: Experience with 179 cases over ten years

Background. Premature infants continue to have a high mortality after gastrointestinal perforation. This report describes 179 patients with gastrointestinal perforation and peritonitis and compares etiologic factors, mortality, and causes of death in premature infants and older children in an attempt to predict outcome. Methods. The 113 boys (63.1%) and 66 girls (36.9%) had an age range of newborn (n=139, 77.6%) to 17 years. Site of perforation was gastric in 16, duodenal in 9, small bowel in 105, colon in 37, and undesignated in 12. Eighteen had multiple perforations. Etiologic factors in newborns (younger than 2 months) included necrotizing enterocolitis (NEC) (75, 41.9%), isolated ileal perforations (30, 21.5%), malrotation/volvulus (8), iatrogenic causes (5), and others (6). Gestational age was 29.6±4.3 weeks for NEC versus 31.4±5.4 weeks for non-NEC. Birth weight for patients with NEC was 1.45±0.8 gm and 1.81±1.0 gm for non-NEC babies. Etiologic factors in 33 older children (older than 2 months to 17 years) were trauma (10), Meckel's diverticulum (4), intussusception (2), pseudomembranous colitis (2), adhesions (2), stomal leak (2), others (4), and nondesignated (7). Gastric perforations (n=16) were iatrogenic in 7, idiopathic in 5 and caused by an ulcer in 4. Results. Mortality for NEC was 36 of 75 (48%), 15 of 55 (27.2%) for non-NEC infants (p