Spontaneous Bowel Perforation in Infants and Young Children: A Clinicopathologic Analysis of Pathogenesis
Resource
JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION v.30 n.4 pp.432- 435
Journal
JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION
Journal Volume
v.30
Journal Issue
435
Pages
-
Date Issued
2000
Date
2000
Author(s)
Chen, Jeng-Chang
Chen, Chiu-Chiang
Liang, Jin-Tung
Abstract
Background: In children beyond the neonatal stage, spontaneous bowel perforation with no specific cause is rare . It has attracted little notice and does not fit into any established clinical category. This often results in treatment delays. To determine the underlying pathogenesis, a clinicopathologic analysis of this group of patients was performed. Methods: From 1984 through 1997, 15 previously healthy children (10 boys and 5 girls) with bowel perforations were enrolled in this study. Children in whom the specific cause was established were excluded. The ages of the patients ranged from 3 months to 5 years, 5 months ( average age: 2 years , 4 months). Data on clinical course, surgical and pathologic findings, and outcomes were analyzed . Results: All the patients had high fever and acute, watery diarrhea with clinical dehydration. Abdominal distension developed and bowel perforation ensued 5 to 30 days after the onset of diarrhea. In all cases, the perforation consisted of either an isolated patch of bowel (n = 8) or patchy lesions in a segment (n = 7), which was confined to one of the following three anatomic watershed areas: the splenic flexure(n = 7); the lower sigmoid (n = 3); and the ileocecal region (n = 5). One patient died, and three had major sequelae including intraabdominal abscess, adhesion ileus, and peristomal fistula. Specimens from 13 patients were submitted for histopathologic evaluation. All specimens had acute suppurative inflammation diffusely around the perforation site. Seven had areas of coagulation necrosis of the muscularis propria, especially in the inner circular muscle layer. Conclusion: In acute diarrheal diseases, dehydration may cause bowel ischemia and lead to perforation . Physicians should be alert to the possibility of this abdominal catastrophe when progressive abdominal distension followed by acute diarrheal episodes occurs in children.
Subjects
bowel perforation
dehydration
diarrhea
ischemia
ISCHEMIC COLITIS
GASTROINTESTINAL PERFORATION
SDGs
Type
journal article