Background
Neonatal intestinal perforation is one condition with a high mortality
rate (1). Its etiologies vary with necrotizing enterocolitis being the
most common at 43.8%. Amongst others include Jejunoileal atresia which
initially presents with intestinal obstruction, while toddlers and
infants may have intussusception causing an intestinal obstruction as
well but a rare phenomenon (2,3). A systematic review by Sebastian et
al, the burden of intestinal atresia was at 54.9% in the studies of
neonatal surgical conditions in Africa with highest mortality
>50% in emergency neonatal surgery (4). In a retrospective
review of babies who had laparotomy for jejunoileal atresia, 69.8% had
ileal atresia and of those, 20.9% had type 1 atresia, meconium
peritonitis was in 43.3% of the cases and was considered to be
secondary to perforation (5). A non-NEC-related perforation can be
idiopathic, secondary to any underlying pathology or a spontaneous
perforation occurring in a normal bowel without any evident cause(6). In
Intestinal obstruction as an underlying pathology mostly presents with
abdominal distension and vomiting for 3 to 4 days in 74% of the
neonates and commonly affected part of the bowel is the terminal ileum
and neonatal gastrointestinal perforation may present with failure to
pass meconium, vomiting, abdominal distension and pneumoperitoneum
(6,7).
A plain radiograph of abdomen continues to be a useful tool for the
diagnosis of neonatal intestinal obstruction demonstrating distended
bowel loop or double bubble in proximal obstruction secondary to
duodenal atresia (8,9)
The management of neonatal intestinal perforation depends on the
aetiological factor and varies to include primary repair, resection and
anastomoses, ileostomy, colostomy, gastrectomy and gastroduodenostomy
(10–12). Though, Hiller et al reported neonates with ileal atresia who
undergo primary resection and anastomosis had a better outcome than
those who had secondary anastomosis, mortality and major complications
are seen in neonates managed with primary anastomoses compared to
ileostomy (13,14)