Etiology and surgical management of pediatric acute colon perforation beyond the neonatal stage

Sarah Siyin Tan,Yajun Chen,Wenbo Pang,Dan Zhang,Chunhui Peng,Kai Wang,Zengmeng Wang,Dongyang Wu

doi:10.1186/s12893-021-01213-3

Sarah Siyin Tan, Yajun Chen + Show 6 more

Open Access

https://doi.org/10.1186/s12893-021-01213-3

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Abstract

PurposeAcute colon perforation is a pediatric surgical emergency. We aimed to analyze the different etiologies and clinical characteristics of acute non-traumatic colon perforation beyond the neonatal period and to identify surgical management and outcomes.MethodsThis retrospective study included 18 patients admitted with acute colon perforation and who received surgical treatment.ResultsAge of patients ranged between 1 month and 15 years. Five patients swallowed foreign objects (two swallowed magnets), two had colon perforation secondary to a malignant tumor (both colorectal adenocarcinoma) and two were iatrogenic (one prior colonoscopy, one air enema for intussusception). There was one perforation due to chemotherapy and Amyand’s hernia respectively. The remaining seven patients had unknown etiologies; five of them were diagnosed with colitis. Fifteen (83.3 %) patients underwent open laparotomy, among which four attempted laparoscopy first. Three (16.7 %) patients underwent laparoscopic surgery. Fourteen (77.8 %) patients received simple suture repairs and four (22.2 %) received colonic resections and anastomosis. Four (22.2 %) patients received a protective diverting colostomy and three (16.7 %) received an ileostomy.ConclusionsThere is a wide range of etiology besides necrotizing enterocolitis and trauma, but a significant portion of children present with unknown etiology. Type of surgery elected should be dependent on the patient’s etiology, disease severity and experience of surgeons.

Highlights

Acute colon perforation is a pediatric surgical emergency and is often discussed in the context of trauma or the neonatal period, where it usually presents itself as a complication of necrotizing enterocolitis (NEC) [1]
The median age was 4.6 years (IQR 0.7–10.2 years), with 8 (44.4 %) patients younger than 2 years old. 11 patients had etiologies which varied from foreign body ingestion, malignant tumor, iatrogenic effect, chemotherapy and strangulated inguinal hernia (Table 1)
We recommend that primary repair be the first choice of treatment and colostomies be performed only when necessary

Summary

Introduction

Acute colon perforation is a pediatric surgical emergency and is often discussed in the context of trauma or the neonatal period, where it usually presents itself as a complication of necrotizing enterocolitis (NEC) [1]. Tan et al BMC Surg (2021) 21:212 of children with non-traumatic colon perforation beyond the neonatal period. We aimed to provide a heightened awareness of different etiologies and their relationship to acute colon perforation, to better equip clinicians who encounter such patients. We aimed to review different surgical managements and their respective outcomes, with the ultimate goal of outlining indications for the different surgical treatment choices

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