Gastrointestinal perforations in the newborn (author's transl)

Abstract

Between 1958 and 1979, 48 neonates with gastrointestinal perforation were treated in the University Clinic, Mainz. The high rate of premature births (c. 40%) was noteworthy, as were the frequent complications in the perinatal period. An accurate diagnosis was made more difficult by the peculiarities of this age, and the multipilicity of possible causes of perforation. The first clinical symptoms were non-specific. In only 36% of the patients was the so-called "pathognomonic" pneumoperitoneum diagnosed on X-ray. The most common site of perforation was the ileo-coecal region, the commonest causes of perforation were intestinal obstruction (atresias, Hirschsprung's disease) and necrotising enterocolitis. In almost 1/3 of all children, the exact causes of perforation could not be determined from the history, intra-operative findings, or histology. The operative procedure depends on the individual case. It must be suited to the site and cause of the perforation, and to the subsequent disturbances. Of the post-operative complications, those related to paediatric intensive-care proved to be more serious than the directly surgical complications. The total mortality was, at 63%, high. The main cause of death was found to be septicemia, and septic complications. An improvement in the results can only be attained through early diagnosis, immediate operation and peri-operative intensive care.