背景:婴儿腹部X线检查时出现意外气腹,提示胃肠穿孔(GIP),有潜在的发病率和死亡率的外科急症。术前确定穿孔位置具有挑战性,但将有助于外科医生优化手术策略。因为结肠穿孔比小肠穿孔更具挑战性。因此,这项研究的目的是提供术前患者特征的概述,确定小肠和结肠之间的差异,并确定一组意外GIP婴儿的根本原因。
方法:回顾性纳入所有在1996年至2024年间在我们中心接受手术的意外气腹(之前没有肺炎迹象)的婴儿(年龄≤6个月)。使用卡方检验和t检验分析穿孔位置之间的差异。Bonferroni校正用于调整多个测试。
结果:总计,在我们中心出现意外气腹的51名婴儿,主要为男性(N=36/51)和早产(N=40/51)。其中,二十六岁有小肠,22个结肠,和三个胃穿孔。早产(p=0.001),出生体重<1000克(p=0.001),呼吸支持(p=0.001),与结肠穿孔相比,小肠穿孔患者的中位动脉pH值较低(p=0.001).肠气中毒在结肠穿孔患者中更多(p=0.004)。所有患有先天性巨结肠和囊性纤维化的患者均有结肠穿孔。最终诊断主要是局灶性肠穿孔(N=27/51)和坏死性小肠结肠炎(N=9/51)。
结论:意外GIP的婴儿,出生体重<1000克,和早产有更多的小肠穿孔的风险。如果是结肠穿孔,应考虑额外的筛查(针对先天性巨结肠和囊性纤维化).
BACKGROUND: Infants presenting with unexpected
pneumoperitoneum upon abdominal X-ray, indicating a gastrointestinal perforation (GIP), have a surgical emergency with potential morbidity and mortality. Preoperative determination of the location of perforation is challenging but will aid the surgeon in optimizing the surgical strategy, as colon perforations are more challenging than small bowel perforations. Therefore, the aim of this
study is to provide an overview of preoperative patient characteristics, determine the differences between the small bowel and colon, and determine underlying causes in a cohort of infants with unexpected GIP.
METHODS: All infants (age ≤ 6 months) who presented at our center with unexpected
pneumoperitoneum (no signs of pneumatosis before) undergoing surgery between 1996 and 2024 were retrospectively included. The differences between the location of perforation were analyzed using chi-squared and t-tests. Bonferroni correction was used to adjust for multiple tests.
RESULTS: In total, 51 infants presented with unexpected
pneumoperitoneum at our center, predominantly male (N = 36/51) and premature (N = 40/51). Among them, twenty-six had small bowel, twenty-two colon, and three stomach perforations. Prematurity (p = 0.001), birthweight < 1000 g (p = 0.001), respiratory support (p = 0.001), and lower median arterial pH levels (p = 0.001) were more present in patients with small bowel perforation compared with colon perforations. Pneumatosis intestinalis was more present in patients with colon perforation (p = 0.004). All patients with Hirschsprung disease and cystic fibrosis had colon perforation. The final diagnoses were mainly focal intestinal perforations (N = 27/51) and necrotizing enterocolitis (N = 9/51).
CONCLUSIONS: Infants with unexpected GIP, birthweight < 1000 g, and prematurity have more risk for small bowel perforation. In case of colon perforation, additional screening (for Hirschsprung and cystic fibrosis) should be considered.