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Pediatric Surgery International

, Volume 23, Issue 10, pp 997–1000 | Cite as

Focal intestinal perforation in extremely-low-birth-weight neonates: etiological consideration from histological findings

  • Akio KubotaEmail author
  • Hiroaki Yamanaka
  • Hiroomi Okuyama
  • Jun Shiraishi
  • Hisayoshi Kawahara
  • Toshimichi Hasegawa
  • Takehisa Ueno
  • Hiroyuki Kitajima
  • Yuko Kuwae
  • Masahiro Nakayama
Original Article

Abstract

In Japan, mortality due to intestinal perforation has been increasing for the last 15 years, as the survival rate of extremely-low-birth-weight neonates (ELBWs) has been increasing. In our NICU, although the incidence of necrotizing enterocolitis has been decreasing, that of focal intestinal perforation (FIP) has been increasing. To elucidate the pathogenesis of FIP, a histological study was performed. For the last 20 years, in our NICU, 11 ELBWs with FIP, including one with multiple perforations and impending rupture, underwent laparotomy and enterostomy. The intestinal wall around the perforation was resected for histological study. Histological studies revealed well-developed ganglion cells in all the cases. Although some lymphocytic infiltration and hemorrhage were observed, no apparent neutrophilic infiltration, or necrotic change was identified in any case. No evidence of microcirculatory impairment was identified. The intestinal musculature discontinued abruptly with thinning in three cases, and without thinning in the others. The histology of impending rupture showed an absence of the muscularis with preservation of the remaining components of the bowel wall. The findings that the punched-out perforations had the appearance of Hirschsprung’s disease, FIP exclusively occurred in ELBWs, and that neither mechanical obstruction nor necrotic change could be identified as the cause of the perforation suggest that immature bowel movement and congenital muscle defects may be involved in the pathogenesis of FIP.

Keywords

Focal intestinal perforation Isolated intestinal perforation Necrotizing enterocolitis Extremely-low-birth-weight neonate Defect of muscular layer 

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Akio Kubota
    • 1
    Email author
  • Hiroaki Yamanaka
    • 1
  • Hiroomi Okuyama
    • 1
  • Jun Shiraishi
    • 2
  • Hisayoshi Kawahara
    • 1
  • Toshimichi Hasegawa
    • 1
  • Takehisa Ueno
    • 1
  • Hiroyuki Kitajima
    • 2
  • Yuko Kuwae
    • 3
  • Masahiro Nakayama
    • 3
  1. 1.Department of Pediatric SurgeryOsaka Medical Center and Research Institute for Maternal and Child HealthOsakaJapan
  2. 2.Department of NeonatologyOsaka Medical Center and Research Institute for Maternal and Child HealthOsakaJapan
  3. 3.Department of PathologyOsaka Medical Center and Research Institute for Maternal and Child HealthOsakaJapan

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