Purpose: Neonatal gastrointestinal perforations continue to be associated with high morbidity and mortality rates. The
aim of this study was to define causes, risk factors, and management of neonatal gastrointestinal perforations; and to
analyze factors relevant to outcome.
Methods: The medical records of 45 neonates treated at Tanta University Hospital for gastrointestinal perforations
during the last 6 years were retrospectively reviewed.
Results: Forty-five infants (25 males and 20 females) were analyzed. Their birth weight ranged from 1100 to 3500 grams
(mean 2200 ± 750 grams). Perforations occurred from birth to 26 days (mean 10.5 days). Main causes of perforations included necrotizing enterocolitis (NEC) (21, 46.7%), spontaneous gastroduodenal perforation (5, 11%), iatrogenic colorectal perforations (4, 8.8%), spontaneous intestinal perforations (3, 6.6%), Hirschsprung's disease (2, 4.4%), and meconium ileus (2, 4.4%). The terminal ileum and cecum were the most frequent sites of perforation. All patients underwent laparotmy except one patient, who died prior to surgical intervention. There were 19 deaths (42.2%). Nearly half of deaths (9, 47.4%) occurred in infants with NEC.
Conclusions: 1: Septicemia, low birth weight, prematurity and delayed recognition of perforation were responsible for
the majority of deaths in our series; 2: Although the overall mortality in this series compares favorably with similar other
large series in the literature, there is still a room for improvement should iatrogenic perforations and delay in diagnosis be avoided: and 3: Simple closure for isolated perforations or resection and primary anastomosis is the treatment of choice, however, creation of stoma in some instances may be warranted.