Russian Journal of Pediatric Surgery, Anesthesia and Intensive CareRussian Journal of Pediatric Surgery, Anesthesia and Intensive CareРоссийский вестник детской хирургии, анестезиологии и реаниматологии2219-40612587-6554Eco-Vector30010.17816/psaic300Short communicationsКраткие сообщенияSPONTANEOUS PERFORATION OF THE INTESTINE IN PREMATURELY BORN CHILDRENСПОНТАННАЯ ПЕРФОРАЦИЯ КИШЕЧНИКА У НЕДОНОШЕННЫХ ДЕТЕЙKozlovYu. A.КозловЮрий Андреевич
Russian Federation

Заведующий отделением хирургии новорожденных

профессор кафедры детской хирургии

профессор кафедры 

NovozhilovV. A.НовожиловВладимир Александрович
Russian Federation

Доктор медицинских наук, заведующий кафедрой детской хирурги,

главный врач

профессор кафедры детской хирургии 

TimofeevA. D.ТимофеевАндрей Дмитриевич
Russian Federation

Ординатор курса детской хирургии факультета повышения квалификации специалистов

Ivan-Matryona Municipal Children’s Clinical Hospital, IrkutskГородская Ивано-Матренинская детская клиническая больница, ИркутскIrkutsk State Medical Academy of Postgraduate EducationИркутская государственная медицинская академия последипломного образованияIrkutsk State Medical UniversityИркутский государственный медицинский университет10122016641021101106201711062017Copyright ©; 2016, Kozlov Y.A., Novozhilov V.A., Timofeev A.D.Copyright ©; 2016, Козлов Ю.А., Новожилов В.А., Тимофеев А.Д.2016Kozlov Y.A., Novozhilov V.A., Timofeev A.D.Козлов Ю.А., Новожилов В.А., Тимофеев А.Д.https://creativecommons.org/licenses/by-nc-nd/4.0https://rps-journal.ru/jour/article/view/300

Intestinal perforation is the most frequent ca-Perforation of the intestine is the most frequent reason for abdominal troubles in premature infants. Etiology of neonatal perforation of the intestinal tube is usually associated with the necrotic enterocolitis (NEC). However, the other reason for pneumoperitoneum in premature and mature newborns is an isolated perforation of the intestine (IPI) which is also known as the spontaneous perforation of the intestine (SPI). The study presents new modern data which confirm the results from many research papers and demonstrate the changes that occurred recently and affected various aspects of the SPI concerning its epidemiology, prevention, treatment and outcome prediction. In the present study we strived to present new knowledge of spontaneous perforation of the intestine, familiarize readers with novel surgical techniques and raise issues of treatment of the disease that remained unclear till now. 

Перфорация кишечника является наиболее частой причиной абдоминальной катастрофы у недоношенных младенцев. Этиология неонатальной перфорации кишечной трубки обычно связана с некротическим энтероколитом (НЭК). Однако другой причиной пневмоперитонеума у недоношенных и доношенных новорожденных является изолированная перфорация кишечника (ИПК), также известная как спонтанная перфорация кишечника (СПК). В исследовании представлены новые современные сведения, которые подтверждают и закрепляют результаты большого количества научных работ и демонстрируют изменения, которые произошли в последние годы и затронули разнообразные стороны СПК, касающиеся ее эпидемиологии, профилактики, лечения и прогнозирования исходов. В настоящем исследовании мы стремились представить новые знания о спонтанной перфорации кишечника, познакомить читателей с современными хирургическими технологиями и поднять вопросы лечения этого заболевания, которые до сих пор не находили ответов. 

spontaneous perforation of the intestineisolated perforation of the intestinenewbornsprematureспонтанная перфорация кишечникаизолированная перфорация кишечникановорожденныенедоношенные1. Vermont Oxford Network Database Manual of Operations for Infants born in 2006 Vermont Oxford Network Releases 9.0–13.2. Available from: http://www.vtoxford.org/tools/ManualofOperationsPart2 .pdf.2. Pumberger W., Mayr M., Kohlhauser C., et al. Spontaneous localized intestinal perforation in very-low-birth-weight infants: a distinct clinical entity different from necrotizing enterocolitis. J Am Coll Surg 2002;195:796–803.3. Mintz A. C., Applebaum H. Focal gastrointestinal perforations not associated with necrotizing enterocolitis in very low birth weight neonates. J Pediatr Surg 1993;28 (6):857–60.4. Huang S. F., Vacanti J., Kozakewich H. Segmental defect of the intestinal musculature of a newborn: evidence of acquired pathogenesis. J Pediatr Surg 1996;31:721–5.5. Tatekawa Y., Muraji T., Imai Y., et al. The mechanism of focal intestinal perforations in neonates with low birth weight. Pediatr Surg Int 1999;15:549–52.6. Miserez M., Barten S., Geboes K., et al. Surgical therapy and histological abnormalities in functional isolated small bowel obstruction and idiopathic gastrointestinal perforation in the very low birth weight infant. World J Surg 2003;27:350–5.7. Hwang H., Murphy J. J., Gow K. W., et al. Are localized intestinal perforations distinct from necrotizing enterocolitis? J Pediatr Surg 2003;38:763–7.8. Holland A. J., Shun A., Martin H. C., et al. Small bowel perforation in the premature neonate: congenital or acquired? Pediatr Surg Int 2003;19:489–94.9. Attridge J. T., Clark R., Walker M. W., et al. New insights into spontaneous intestinal perforation using a national data set: (2) two populations of patients with perforations. J Perinatol 2006;26:185–8.10. Steiner D. H., Maxwell J. G., Rasmussen B. L., et al. Segmental absence of intestinal musculature. An unusual cause of intestinal obstruction in the neonate. Am J Surg 1969;118:964–7.11. Adesanya O. A., O’Shea T. M., Turner C. S., Amoroso R. M., Morgan T. M., Aschner J. L. Intestinal perforation in very low birth weight infants: growth and neurodevelopment at 1 year of age. J Perinatol 2005;25:583–9.12. Boston V. E. Necrotising enterocolitis and localised intestinal perforation: different diseases or ends of a spectrum of pathology. Pediatr Surg Int 2006;22:477–84.13. Koshinaga T., Gotoh H., Sugito K., Ikeda T., Hagiwara N., Tomita R. Spontaneous localized intestinal perforation and intestinal dilatation in very-low-birthweight infants. Acta Paediatr. 2006;95:1381–8.14. KubotaA., Yamanaka H., Okuyama H., Shiraishi J., Kawahara H., Hasegawa T., et al. Focal intestinal perforation in extremely-low-birth-weight neonates: etiological consideration from histological findings. Pediatr Surg Int. 2007;23:997–1000.15. Tepas J. J., 3rd, Sharma R., Hudak M. L., et al. Coming full circle: an evidence-based definition of the timing and type of surgical management of very low-birth-weight (16. Nguyen H., Lund C. H. Exploratory laparotomy or peritoneal drain? Management of bowel perforation in the neonatal intensive care unit. J Perinat Neonatal Nurs 2007;21:50–60.17. Aschner J. L., Deluga K. S., Metlay L. A., et al. Spontaneous focal gastrointestinal perforation in very low birth weight infants. J Pediatr 1988;113:364–367.18. Horbar J. D., Carpenter J. H., Badger G. J., et al. Mortality and neonatal morbidity among infants 501 to 1500 grams from 2000 to 2009. Pediatrics 2012;129:1019–1026.19. Grosfeld J. L., Molinari F., Chaet M., et al. Gastrointestinal perforation and peritonitis in infants and children: experience with 179 cases over ten years. Surgery 1996;120:650–655; discussion 655–656.20. Attridge J. T., Clark R., Walker M. W., et al. New insights into spontaneous intestinal perforation using a national data set: (1) SIP is associated with early indomethacin exposure. J Perinatol 2006;26:93–99.21. Blakely M. L., Tyson J. E., Lally K. P., et al. Laparotomy versus peritoneal drainage for necrotizing enterocolitis or isolated intestinal perforation in extremely low birth weight infants: outcomes through 18 months adjusted age. Pediatrics 2006;117:680–687.22. Blakely ML, Lally KP, McDonald S, et al. Postoperative outcomes of extremely low birth-weight infants with necrotizing enterocolitis or isolated intestinal perforation: a prospective cohort study by the NICHD Neonatal Research Network. Ann Surg 2005;241:984–989; discussion 989–99423. Lai S., Yu W., Wallace l., Sigalet D. Intestinal muscularis propria increases in thickness with corrected gestational age and is focally attenuated in patients with isolated intestinal perforations. J Pediatr Surg 49;2014:114–119.24. Meyer C. L., Payne N. R., Roback S. A. Spontaneous, isolated intestinal perforations in neonates with birth weight less than 1,000 g not associated with necrotizing enterocolitis. J Pediatr Surg. 1991;26:714–7.25. Drewett M. S., Burge D. M. Recurrent neonatal gastro-intestinal problems after spontaneous intestinal perforation. Pediatr Surg Int 2007;23:1081–4.26. Stephens D., Arensman R., Pillai S. et al. Congenital absence of intestinal smooth muscle: a case report and review of the literature. J Pediatr Surg 2009;44: 2211–5.27. Attridge J. T., Clark R., Gordon P. V. New insights into spontaneous intestinal perforation using a national data set (3): antenatal steroids have no adverse association with spontaneous intestinal perforation. J Perinatol 2006;26: 667–70.28. Ragouilliaux C. J., Keeney S. E., Hawkins H. K., Rowen J. L. Maternal factors in extremely low birth weight infants who develop spontaneous intestinal perforation. Pediatrics. 2007; 120:1458–64.29. Vanhaesebrouk P., Theiry M., Leroy J. G., et al. Oligohydramnions, renal insufficiency and ileal perforation in preterm infants after intrauterine exposure to indomethacin. J Pediatr 1988;113:738–43.30. Rogers M. S., Murray H. G., Wang C. C., Pennell C. E., Turner A., Yan P., et al. Oxidative stress in the fetal lamb brain following intermittent umbilical cord occlusion: a path analysis. Br J Obstet Gynaecol. 2001;108:1283–90.31. Quaedackers J. S., Roelfsema V., Heineman E., Gunn A. J., Bennet L. The role of the sympathetic nervous system in postas- phyxial intestinal hypoperfusion in the pre-term sheep fetus. J Physiol. 2004;557:1033–44.32. Ratcliffe J. F., Lisle D. Re: Idiopathic localized dilatation of the ileum. Am J Roentgenol. 1996;166:465–6.33. Gray S. W., Skandalakis J. E. Embryology for surgeons. Philadelphia: WB Saunders; 1972. p. 129–33.34. Kai K., Sameshima H., Ikeda T., Ikenoue T. Severe variable deceleration is associated with intestinal perforation in infants born at 22–27 weeks’ gestation. J Matern Fetal Neonatal Med. 2009;22:259–64.35. Nakajima Y., Masaoka N., Yamamoto T. Obstetrical risk factors for focal intestinal perforation in very low birth weight infants. J Perinat. Med 2011;39:179–184.36. Carrol Jr. R. L. Absence of musculature of the distal ileum as a cause of neonatal intestinal obstruction. J Pediatr Surg 1973;8:29–31.37. Tibboel D., Gaillard J. L., Molenaar J. C. The importance of mesenteric vascular insufficiency in meconium peritonitis. Hum Pathol 1986;17:411–6.38. Alawadhi A., Chou S., Carpenter B. Segmental agenesis of intestinal muscularis: a case report. J Pediatr Surg 1989;24:1089–90.39. Gordon P. V. Understanding intestinal vulnerability to perforation in the extremely low birth weight infant. Pediatr Res 2009;65:138–44.40. Gordon P. V., Young M. L., Marshall D. D. Focal small bowel perforation: an adverse effect of early postnatal dexamethasone therapy in extremely low birth weight infants. J Perinatol 2001;21:156–60.41. Stark A. R., Carlo W. A., Tyson J. E., Papile L. A., Wright L. L., Shankaran S., et al. Adverse effects of early dexamethasone in extremely-low-birth-weight infants. N Engl J Med 2001;344: 95–101.42. Schmidt B., Davis P., Moddemann D., et al. Trial of Indomethacin Prophylaxis in Preterms Investigators. Long-term effects of indomethacin prophylaxis in extremely- low-birth-weight infants. N Engl J Med. 2001;344:1966–1972.43. Watterberg K. L., Gerdes J. S., Cole C. H., et al. Prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia: a multicenter trial. Pediatrics 2004;114:1649–57.44. Paquette L., Friedlich P., Ramanathan R., Seri I. Concurrent use of indomethacin and dexamethasone increases the risk of spontaneous intestinal perforation in very low birth weight neonates. J Perinatol 2006;26:486–92.45. Fowlie P. W., Davis P. G., McGuire W. Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants. Cochrane Database Syst Rev 2010;7 CD000174.46. Wadhawan R., Oh W., Vohr B. R., et al. Spontaneous intestinal perforation in extremely low birth weight infants: association with indometacin therapy and effects on Jones and Fisher 6 neurodevelopmental outcomes at 18–22 months corrected age. Arch Dis Child 2013;98:127–132.47. Gordon P. V., Attridge J. T. Understanding clinical literature relevant to spontaneous intestinal perforations. Am J Perinatol 2009;26:309–16.48. Roberts D., Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006;3 CD004454.49. Haas D. M., Imperiale T. F., Kirkpatrick P. R., et al. Tocolytic therapy: a meta-analysis and decision analysis. Obstetrics & Gynecology 2009;113:585–94.50. Kawase Y., Ishii T., Arai H., et al. Gastrointestinal perforation in very low- birthweight infants. Pediatr Int 2006;48:599–603.51. Nagaraj H. S., Sandhu A. S., Cook L. N., et al. Gastrointestinal perforation following indomethacin therapy in very low birth weight infants. J Pediatr Surg 1981;16:1003–1007.52. Alpan G., Eyal F., Vinograd I., et al. Localized intestinal perforations after enteral administration of indomethacin in premature infants. J Pediatr 1985;106:277–281.53. Clyman R. I. Ibuprofen and patent ductus arteriosus. N Engl J Med 2000;343: 728–30.54. Jones L. J., Craven P. D., Attia J., et al. Network meta-analysis of indomethacin versus ibuprofen versus placebo for PDA in preterm infants. Arch Dis Child Fetal Neonatal Ed 2011;96:45–52.55. van der Lugt N. M., Lopriore E., Bokenkamp R., et al. Repeated courses of ibuprofen are effective in closure of a patent ductus arteriosus. Eur J Pediatr 2012;171: 1673–7.56. Garland J. S., Alex C. P., Pauly T. H., et al. A three-day course of dexamethasone therapy to prevent chronic lung disease in ventilated neonates: a randomized trial. Pediatrics 1999;104:91–99.57. Halliday H. L., Ehrenkranz R. A., Doyle L. W. Early (< 8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database Syst Rev 2010; CD001146.58. Halliday H. L., Ehrenkranz R. A., Doyle L. W. Late (>7 days) postnatal corticosteroids for chronic lung disease in preterm infants. Cochrane Database Syst Rev 2009; CD001145.59. Anonymous. Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants. Paediatrics & Child Health 2002;7:20–46.60. Kelleher J., Salas A., Bhat B., et al. Prophylactic Indomethacin and Intestinal Perforation in Extremely Low Birth Weight Infants. Pediatrics 2014;134;1369–77.61. Karagianni P., Briana D. D., Mitsiakos G., et al. Early versus delayed minimal enteral feeding and risk for necrotizing enterocolitis in preterm growth-restricted infants with abnormal antenatal Doppler results. Am J Perinatol. 2010;27:367–373.62. Leaf A., Dorling J., Kempley S., et al. Early or delayed enteral feeding for preterm growth-restricted infants: a randomized trial. Pediatrics. 2012;129:1260–1268.63. Raval M., Hall N., Pierro A., Moss R. L. Evidence-based prevention and surgical treatment of necrotizing enterocolitis – A review of randomized controlled trials. Seminars in Pediatric Surgery 2013;22: 117–121.64. Clyman R., Wickremasinghe A., Jhaveri N., et al. Enteral feeding during indomethacin and ibuprofen treatment of a patent ductus arteriosus. J Pediatr. 2013;163:406–411.65. Moss R. L., Dimmitt R. A., Barnhart D. C., et al. Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation. N Engl J Med 2006;354:2225–2234.66. Rees C. M., Eaton S., Kiely E. M., et al. Peritoneal drainage or laparotomy for neonatal bowel perforation? A randomized controlled trial. Ann Surg 2008;248:44–51.67. Rao S. C., Basani L., Simmer K., et al. Peritoneal drainage versus laparotomy as initial surgical treatment for perforated necrotizing enterocolitis or spontaneous intestinal perforation in preterm low birth weight infants. Cochrane Database Syst Rev. 2011; (6):CD006182.68. Gordon P. V., Swanson J. R., Attridge J. T., et al. Emerging trends in acquired neonatal intestinal disease: is it time to abandon Bell’s criteria? J Perinatol 2007;27:661–671.69. Cheu H. W., Sukarochana K., Lloyd D. A. Peritoneal drainage for necrotizing enterocolitis. J Pediatr Surg 1988;23:557–561.70. Ein S. H., Shandling B., Wesson D., et al. A 13-year experience with peritoneal drainage under local anesthesia for necrotizing enterocolitis perforation. J Pediatr Surg 1990;25:1034–1036; discussion 1036–1037.71. Cass D. L., Brandt M. L., Patel D. L., et al. Peritoneal drainage as definitive treatment for neonates with isolated intestinal perforation. J Pediatr Surg 2000;35:1531–1536.