Long term outcome of preterm infants with isolated intestinal perforation: A comparison between primary anastomosis and ileostomy

Infographic · Oct 2018 · 1 min read

In brief

This retrospective study of 23 preterm infants with isolated intestinal perforation found significantly higher mortality (50% vs 0%) and major complications in those treated with primary anastomosis compared to ileostomy. The findings suggest ileostomy may be safer than primary anastomosis for this vulnerable population.

Primary anastomosis in preterm infants with isolated intestinal perforation had 50% mortality vs 0% with ileostomy (p=0.019).
Late necrotizing enterocolitis developed in 6 patients, all in the primary anastomosis group, with 4 deaths (p=0.048).
Major complications occurred significantly more in primary anastomosis group (71%) compared to ileostomy (11%, p=0.029).
Ileostomy remains safer than primary anastomosis for isolated intestinal perforation in preterm infants despite longer treatment course.
Surgeon judgment without protocol led to treatment selection; results suggest ileostomy should be preferred in this fragile population.

Written by the GCMD Library team from the infographic.

The infographic uses a light teal background with a structured layout comparing two surgical approaches. Simple line drawings illustrate a stoma (shown as a single opening with red circle) versus primary anastomosis (shown as continuous bowel loops). A table format presents mortality, complications, and late NEC rates for each approach, with the stoma group showing consistently better outcomes.

Aim of the study

Management of isolated intestinal perforation (IIP) poses a challenge for the pediatric surgeon. Intestinal resection and primary anastomosis is considered to be as good as the classical approach, namely, intestinal diversion by ileostomy. However, few reports compare primary anastomosis and ileostomy as IIP treatment. In our institution we favored primary anastomosis as first line treatment whenever patient's condition permitted. Our purpose is to retrospectively compare the outcomes of preterm infants treated with primary anastomosis or ileostomy during a laparotomy in which an IIP was found.

Method

We identified all newborns who had abdominal operations for IIP from 2000 through 2013. Patients with extensive necrotizing entorocolitis and comorbidities were excluded, as well as those who died in the first 24 h. Demographics, type of treatment and complications were reviewed. Major complications included the need for an urgent reoperation, development of late NEC and death.

Results

Twenty-three patients with a median gestational age (GA) of 27 weeks and median birth weight (BW) of 883 g had receive two types of treatment: group I included 9 patients who had intestinal resection of the affected bowel and ileostomy; group PA consisted of 14 patients who had intestinal resection and primary anastomosis. The decision to perform PA or I was based on the surgeon's judgment, in the absence of a specific protocol. There were no significant differences in GA and BW between both groups. Overall mortality was 30.4%. However mortality was restricted to group PA (n = 7 cases; 50%) (p = 0.019). Most major complications occurred in group PA (71% vs. 11%, p = 0.029). There were six cases of late NEC, all in group PA (p = 0.048), and four of those patients died. Other than the type of treatment, no differences could be identified between both groups.