Neonatal gastro-intestinal tract perforation in Mosul city

Abstract

Background: Gastro-intestinal perforation (GIP) of neonates considered as one of the foremost emergency problems faced by pediatric surgeons around the world. It represents important challenges with a high mortality of 15-70% has been reported. Despite enhancements in anesthesia, as well as, intensive care, mortality has remained high, especially in premature babies. Patients and Methods: A retrospective series study including 50 patients diagnosed as GIT perforation were admitted to the neonatal pediatric surgery center in Al-Khansaa teaching hospital, allocated over the period extending from April 2017 to June 2019. Records were reviewed for the age, sex, gestational age, weight, duration of symptoms, associated anomalies, causes of GIT perforation, procedure done, mortality, amorbidity, and hospital stay period. Leak from intestinal anastomosis secondary to resection as surgical interference were excluded from the study. Results: The presentation age varied between 12 hours to 27 days with a median age of 3.5 days. The weight mean is 2.93 kg. The mean gestation age was 34 weeks, ranging from 30-42 weeks. The majority had the symptoms before 30 hours. Most of the sample is within the 1 st week representing 86.0%. The males are representing 76.0% while the females are 24.0% with a ratio about of (3:1). About 56.0% of the perforations occur in the small bowel and only 4.0% in appendix. The large bowel represents 28.0% and the stomach 12.0%. The positive findings of abdominal X-Ray are found in 80.0% of patients. 40.0% of patients are died. The frequent site is the ileum, found in 8 patients (40.0%) of all deaths. Next are the Jejunum and colon, representing 20.0% for each. The stomach pathology found in 10.0%, as well as, the cecum 10.0%. Conclusion: The commonest site of perforation is small bowel. History, clinical picture and erect abdominal X-ray are very important for the diagnosis. The risk factors raise the mortality rate include malnutrition, the appearance of complications, lack of certain drugs, delayed diagnosis, prematurity, and associated anomalies. The outcome is improved with early identification, diagnosis, and treatment. AIM OF THE STUDY : To study the causes and outcome of neonatal GIT perforations in Mosul city and its drainage areas in the north of Iraq.