Neonatal Gastrointestinal Perforation.

Abstract

Twenty four neonates with gastrointestinal perforations (GIP) were studied prospectively over a period of two years. The purpose of study was to determine the causes, locations and mortality of these perforations in this part of the world. Out of 24 neonates, there were 16 males and 8 females. All were operated and each had a solitary perforation. Fifteen (62.5%) had idiopathic or spontaneous perforations, 4(16.6%) developed perforation secondary to distal obstruction, 3(12.5%) perforations were due to Narcotising Enterocolitis (NEC) whereas 2(8.4%) were iatrogenic in nature. Three (12.5%) perforations were located in stomach, 11(45.8%) involved mall bowel whereas 10(41.7%) were in large bowel. Hirschsprung’s disease, Colonic atresia and Imperforate anus of high variety were the obstructive causes of perforations. The size of perforation ranged from pinhole to about 1cm. simple closure of perforation was performed in 12(50%) cases, resection and anastomosis was done in 3(12.8%), whereas exteriorization of perforation was carried out in 8(33.3%) cases. Bishop koop operation was performed in 2(8.3%) cases. Overall mortality rate was 37.5% with highest (66.6%) mortality associated with gastric perforations whereas mortality rate of small and large bowel perforations were 27% and 40%respectively. Delay in reporting to the hospital resulting in septic shock and imbalance of fluid and electrolytes was responsible for high mortality associated with neonatal gastrointestinal perforation.