scholarly journals Can Neonatal Pneumoperitoneum be Managed by Conservative Management Alone?

2013 ◽  
Vol 32 (3) ◽  
pp. 252-253
Author(s):  
Sananda Pati ◽  
Bhushan Chaki ◽  
Atanu Roy ◽  
Sangita De
Keyword(s):  
Mechanical Ventilation ◽  
Intestinal Perforation ◽  
Vital Signs ◽  
Exploratory Laparotomy ◽  
Necrotising Enterocolitis ◽  
Uneventful Recovery ◽  
Peritoneal Drainage ◽  
Common Causes ◽  
Focal Intestinal Perforation ◽  
Definitive Management

Common causes of pneumoperitoneum in neonates includes necrotising enterocolitis (NEC), specific infections, gastro intestinal obstruction, iatrogenic causes, idiopathic focal intestinal perforation, perforation secondary to intra thoracic pathology, mechanical ventilation etc. Primary peritoneal drainage and exploratory laparotomy remain the definitive management of pneumoperitoneum in neonates. Here we report a case of suspected spontaneous idiopathic intestinal perforation managed conservatively with monitoring of vital signs. The neonate had an uneventful recovery. This case highlights the need to identify infants with benign or non surgical causes of pneumoperitoneum thus avoiding unnecessary laparotomies and referrals in these vulnerable neonates. DOI: http://dx.doi.org/10.3126/jnps.v32i3.5912 J. Nepal Paediatr. SocVol.32(3) 2012 252-253

scholarly journals Spontaneous Intestinal Perforation in Neonates

2015 ◽  
Vol 4 (2) ◽  
Author(s):  
Charu Tiwari ◽  
Gursev Sandlas ◽  
Shalika Jayaswal ◽  
Hemanshi Shah
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Intestinal Perforation ◽  
Very Low Birth Weight ◽  
Bowel Perforation ◽  
Exploratory Laparotomy ◽  
Peritoneal Drainage ◽  
Birth Weight Neonate ◽  
The Mean ◽  
Spontaneous Intestinal Perforation

Background: The term Spontaneous Intestinal Perforation (SIP) suggests a perforation in the gastrointestinal tract of a newborn with no demonstrable cause.Methods: Four neonates presenting with spontaneous bowel perforation were analyzed with respect to clinical presentation, management and outcome.Results: The mean age at presentation was 11.4 days. There were three males and one female. One of the neonates was preterm, very low birth weight and the other three were full term. Two neonates underwent emergency exploratory laparotomy and two were initially managed by peritoneal drainage in view of poor general condition; one of them improved and did not require further operative intervention. The preterm very low birth weight neonate was stabilized and explored after 48 hours. Intra-operatively, two of them had two ileal perforations each which required ileostomy; one had single perforation in the transverse colon which was primarily repaired. All four had an uneventful recovery.Conclusion: SIP is a distinct clinical entity and has better outcome than neonates with intestinal perforation secondary to Necrotizing Enterocolitis (NEC).

scholarly journals Efficacy of Peritoneal Drainage for Focal Intestinal Perforation

2018 ◽  
Vol 7 (2) ◽  
pp. 20
Author(s):  
Shunusuke Watanabe ◽  
Tatsuya Suzuki ◽  
Yasuhiro Kondo ◽  
Atsuki Naoe ◽  
Naoko Uga ◽  
...  
Keyword(s):  
Intestinal Perforation ◽  
Neonatal Intensive Care ◽  
Bowel Function ◽  
Poor General Condition ◽  
C Reactive Protein ◽  
Inflammatory Infiltration ◽  
Reactive Protein ◽  
Peritoneal Drainage ◽  
Significant Difference ◽  
Focal Intestinal Perforation

Objective: Focal intestinal perforation (FIP), which is characterized by the lack of inflammatory infiltration peripheral to the perforation, develops with few premonitory symptoms. The treatment typically involves laparotomy for drainage or percutaneous drain insertion. We retrospectively investigated the efficacy and risks associated with laparotomy-assisted drainage and peritoneal drainage (PD) for FIP. StudyDesign: This was a retrospective, comparative study.Results: We retrospectively evaluated seven infants with FIP who were admitted to the neonatal intensive care unit between April 2007 and March 2017. Five infants were administered indomethacin and six were administered steroids. The PD group had significantly higher birth weight, higher C-reactive protein (CRP) levels, and shorter operating times. In addition, they gained weight postoperatively but often required adjuvant therapy for bowel function. There was no significant difference between the groups regarding the time to post-operative full feeding, and all infants showed improved physical appearance.Conclusions: PD under local anesthesia can be considered for treating infants with FIP who have elevated CRP levels and poor general condition. We think management of this condition is still challenging in our experience, and it is necessary to continue in the future.

Discriminating necrotising enterocolitis and focal intestinal perforation

2021 ◽  
pp. fetalneonatal-2020-321429
Author(s):  
Janet Berrington ◽  
Nicholas D Embleton
Keyword(s):  
Clinical Trials ◽  
Quality Improvement ◽  
Preterm Infants ◽  
Gestational Age ◽  
Intestinal Perforation ◽  
Necrotising Enterocolitis ◽  
Single Centre ◽  
Detailed Review ◽  
Focal Intestinal Perforation ◽  
Key Features

Discriminating necrotising enterocolitis (NEC) and focal intestinal perforation (FIP) is important for clinical trials, observational cohorts, quality improvement and aetiological understanding. Literature suggests that timing and key features diagnose and discriminate, and that NEC subclassifications exist. We used a detailed 10-year cohort of NEC and FIP cases in preterm infants born <32 weeks’ gestation from a single centre to explore antecedent factors, presentation and potential NEC subclassifications. 785 infants had 144 episodes of NEC and 38 of FIP. FIP presented earlier than NEC, but ranges overlapped, and 30% of NEC presented before day 14. Antecedent events (other than feed volumes) and outcomes did not differ between NEC and FIP. Currently used diagnostic/discriminatory features performed poorly, and subclassification identified few cases except transfusion-associated NEC. Contrary to existing literature, postnatal age at NEC presentation was not dependent on gestational age. Detailed review rather than simple definitions are required to separate NEC from FIP.

scholarly journals Case Report: Delayed Perforation after Definitive Treatment of Focal Intestinal Perforation with a Peritoneal Drain

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Brian G. A. Dalton ◽  
Kenneth C. Walters ◽  
Melvin S. Dassinger
Keyword(s):  
Case Report ◽  
Premature Infant ◽  
Intestinal Perforation ◽  
Initial Presentation ◽  
Definitive Treatment ◽  
First Report ◽  
Peritoneal Drainage ◽  
Focal Intestinal Perforation ◽  
Delayed Perforation ◽  
Initial Episode

Focal intestinal perforation (FIP) has long been described in the pediatric literature. Peritoneal drainage (PD) is widely used as treatment for focal intestinal perforation. Here we report a premature infant that underwent PD on day of life 9 for a FIP. The infant recovered well from this episode and was discharged home without known sequelae. Subsequently, the same patient presented 16 months later with peritonitis. A perforation was discovered at laparotomy without evidence of surrounding necrosis. Given this finding, we believe this second episode of perforation was at the same site as the initial episode of FIP. The finding of FIP has been described without findings of surrounding necrosis. However, we believe this to be the first report of delayed perforation greater than 1 year from initial presentation after FIP treated definitively with peritoneal drain.

scholarly journals Necrotizing enterocolitis and focal intestinal perforation in neonatal intensive care units in the state of Baden-Württemberg, Germany

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Thomas Böhler ◽  
Ingo Bruder ◽  
Peter Ruef ◽  
Jörg Arand ◽  
Manfred Teufel ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Intensive Care ◽  
Intestinal Perforation ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Necrotising Enterocolitis ◽  
The State ◽  
Neonatal Intensive Care Units ◽  
Vlbw Infants ◽  
Focal Intestinal Perforation

In preterm infants with very low birth weight (VLBW) &lt;1500 g the most important acquired intestinal diseases are necrotising enterocolitis (NEC) and focal intestinal perforation (FIP). We analyzed data of the neonatology module of national external comparative quality assurance for inpatients in the state of Baden-Württemberg, Germany. Between 2010 and 2012, 59 of 3549 VLBW infants developed FIP (1.7%), 128 of them NEC (3.6%). In approximately 3% of infants with BW&lt;1000 g FIP was diagnosed, which was nearly 9 times more often than in infants with BW between 1250 and 1499 g (FIP frequency 0.36%). NEC frequency increased with decreasing BW and was more than 10 times higher in the smallest infants (BW&lt;750 g: 7.87%) compared to those with BW between 1250 and 1499 g (0.72%). The BW limit of 1250 g differentiates between groups of patients with distinguished risks for NEC and FIP.

Torsion of the gallbladder: a rare but important differential to consider when treating acute cholecystitis non-operatively

2021 ◽  
Vol 14 (1) ◽  
pp. e237842
Author(s):  
Arun Ahluwalia ◽  
Matthew George Roy Allaway ◽  
Serena Giga ◽  
Richard James Curran
Keyword(s):  
Acute Cholecystitis ◽  
Inflammatory Markers ◽  
Epigastric Pain ◽  
Vital Signs ◽  
Rare Condition ◽  
Liver Function Tests ◽  
Uneventful Recovery ◽  
Imaging Characteristics ◽  
Gallbladder Torsion ◽  
Torsion Of The Gallbladder

A 79-year-old woman presented with postprandial epigastric pain. She had normal vital signs, inflammatory markers and liver function tests. Ultrasound and CT of the abdomen demonstrated features consistent with acute cholecystitis. Her medical comorbidities and extensive abdominal surgical history prompted the decision to treat non-operatively. Despite optimal medical management, worsening abdominal pain and uptrending inflammatory markers developed. She underwent an emergency laparoscopy which revealed a necrotic gallbladder secondary to an anticlockwise complete gallbladder torsion; a rare condition associated with significant morbidity and mortality if managed non-operatively. Laparoscopic cholecystectomy was achieved without complication and the patient had an uneventful recovery. Preoperative diagnosis of torsion of the gallbladder is difficult. However, there are certain patient demographics and imaging characteristics that can help surgeons differentiate it from acute cholecystitis; a condition which can be safely managed non-operatively in selected patients. The differentiating features are elaborated on in this case report.

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