Indian Journal of Surgery

, Volume 79, Issue 5, pp 431–436 | Cite as

Neonatal Gastrointestinal Perforations: the 10-Year Experience of a Reference Hospital

  • Mehmet SaraçEmail author
  • Ünal Bakal
  • Mustafa Aydın
  • Tugay Tartar
  • Aysen Orman
  • Erdal Taşkın
  • Şenay Canpolat
  • Ahmet Kazez
Original Article


The aim of this study was to present our experiences with, as well as the factors that affect, the treatment and outcome of patients with neonatal gastrointestinal perforations (GIPs). Thirty-eight newborn cases that were operated on for GIP in our hospital’s tertiary newborn intensive care unit between January 2005 and December 2015 were retrospectively evaluated. The patients were divided into the two following groups: group 1, perforations related to necrotizing enterocolitis (NEC), and group 2, non-NEC perforations. In total, 38 patients (16 males, 22 females) participated in this study. The perforations were related to NEC in 12 patients (group 1; 31.6 %), and the other 26 patients (group 2; 68.4 %) were classified as non-NEC perforation cases. The incidence of neonatal GIP was 0.53 % in all newborn patients, while the incidence of perforation in NEC cases was 20 %. Of all patients, 25 (65.7 %) were premature. Non-NEC pathologies were the most common cause of GIP (68.4 %) and included stomach perforation related to a nasogastric catheter (n = 5), volvulus (n = 4), intestinal atresia (n = 3), esophageal atresia and tracheoesophageal fistula (n = 2), cystic fibrosis (n = 2), Hirschprung’s disease (n = 2), appendicitis (n = 2), congenital stomach anterior wall weakness (n = 1), duplication cyst (n = 1), invagination (n = 1), incarcerated inguinal hernia (n = 1), and idiopathic causes (n = 2). Primary surgical repair was performed in all cases without a conservative approach. The mortality rate related to GIP in newborn cases was 47.3 %. While the mortality rate in group 1 was 66.6 %, it was statistically insignificantly lower in group 2 (38.4 %) (p > 0.05). In group 1, the mortality rate of those with intestinal and colorectal perforations was 45.6 and 20 %, respectively (p > 0.05). Non-NEC pathologies are the most frequent causes of GIP in newborns, and primary surgical repair is the primary treatment choice for neonatal GIP. However, GIP remains one of the most significant causes of mortality in newborns. While the prognosis for neonatal colon perforation is good, that for stomach and jejunoileal perforations is worse.


Newborn infant Gastrointestinal perforation Necrotizing enterocolitis Mortality 


Compliance with Ethical Standards

Research Involving Human Participants and/or Animals

This is a retrospective study.

Informed Consent

Formal and written informed consents were obtained from parents.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Venkatesh MA, Vijay K, Rashmi VA, Mahesh M, Anil BH (2013) Gastrointestinal perforation in neonates. Karnataka Paediatric Journal 28:140–146Google Scholar
  2. 2.
    Sakellaris G, Partalis N, Dede O, Alegakis A, Seremeti C, Korakaki, Giannakopoulou C (2012) Gastrointestinal perforations in neonatal period: experience over 10 years. Pediatr Emerg Care 28:886–888CrossRefPubMedGoogle Scholar
  3. 3.
    Hakan N, Aydin M, Erdogan D, Cavusoglu YH, Dursun A, Zenciroglu A, Okumus N, Ozguner IF, Karaman A, Karaman I (2013) Neonatal gastrointestinal perforations: a 7-year single center experience at a tertiary neonatal intensive care unit in Turkey. CIBTech Journal of Surgery 3:1–7Google Scholar
  4. 4.
    Attridge JT, Herman AC, Gurka MJ, Griffin MP, McGahren ED, Gordon PV (2006) Discharge outcomes of extremely low birth weight infants with spontaneous intestinal perforations. J Perinatol 26:49–54CrossRefPubMedGoogle Scholar
  5. 5.
    Walsh MC, Kliegman RM (1986) Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin N Am 33:179–201CrossRefGoogle Scholar
  6. 6.
    do Lee K, Shim SY, Cho SJ, Park EA, Lee SW (2015) Comparison of gastric and other bowel perforations in preterm infants: a review of 20 years’ experience in a single institution. Korean J Pediatr 58:288–293CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kazez A, Yekeler H, Turgut M, Apak S, Parmaksız E (1996) Idiopathic focal intestinal perforation in low birth weight neonates. Pediatrik Cerrahi Dergisi 10:21–24Google Scholar
  8. 8.
    Emil S, Davis K, Ahmad I, Strauss A (2008) Factors associated with definitive peritoneal drainage for spontaneous intestinal perforation in extremely low birth weight neonates. Eur J Pediatr Surg 18:80–85CrossRefPubMedGoogle Scholar
  9. 9.
    Boston VE (2006) Necrotising enterocolitis and localised intestinal perforation: different diseases or ends of a spectrum of pathology. Pediatr Surg Int 22:477–484CrossRefPubMedGoogle Scholar
  10. 10.
    St-Vil D, LeBouthillier G, Luks FI, Bensoussan AL, Blanchard H, Youssef S (1992) Neonatal gastrointestinal perforations. J Pediatr Surg 27:1340–1342CrossRefPubMedGoogle Scholar
  11. 11.
    Nakamura H, Hirano K, Watanabe K (2003) Gastrointestinal perforation in 31 neonates with surgical treatment: statistical analysis by quantification theory type in. Journal of the Japanese Society of Pediatric Surgeons 39:748–757Google Scholar
  12. 12.
    Hyginus EO, Jideoffor U, Victor M, N OA (2013) Gastrointestinal perforation in neonates: aetiology and risk factors. J Neonatal Surg 2:30PubMedPubMedCentralGoogle Scholar
  13. 13.
    Chung MT, Kuo CY, Wang JW, Hsieh WS, Huang CB, Lin JN (1994) Gastric perforation in the neonate: clinical analysis of 12 cases. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 35:460–465PubMedGoogle Scholar
  14. 14.
    Singh M, Owen A, Gull S, Morabito A, Bianchi A (2006) Surgery for intestinal perforation in preterm neonates: anastomosis vs. stoma. J Pediatr Surg 41:725–729CrossRefPubMedGoogle Scholar
  15. 15.
    Ohshiro K, Yamataka A, Kobayashi H, Hirai S, Miyahara K, Sueyoshi N, Suda K, Miyano T (2000) Idiopathic gastric perforation in neonates and abnormal distribution of intestinal pacemaker cells. J Pediatr Surg 35:673–676CrossRefPubMedGoogle Scholar
  16. 16.
    Yamataka A, Yamataka T, Kobayashi H, Sueyoshi N, Miyano T (1999) Lack of C-KIT + mast cells and the development of idiopathic gastric perforation in neonates. J Pediatr Surg 34:34–38CrossRefPubMedGoogle Scholar
  17. 17.
    Calisti A, Perrelli L, Nanni L, Vallasciani S, D’Urzo C, Molle P, Briganti V, Assumma M, De Carolis MP, Maragliano G (2004) Surgical approach to neonatal intestinal perforation. An analysis on 85 cases (1991–2001). Minerva Pediatr 56:335–339PubMedGoogle Scholar
  18. 18.
    Fenton TR (2003) A new growth chart for preterm babies: Babson and Benda’s chart updated with recent data and a new format. BMC Pediatr 3:13CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Duran R, Inan M, Vatansever U, Aladağ N, Acunaş B (2007) Etiology of neonatal gastric perforations: review of 10 years’ experience. Pediatr Int 49:626–630CrossRefPubMedGoogle Scholar
  20. 20.
    Oztürk H, Onen A, Otçu S, Dokucu AI, Gedik S (2003) Gastric perforation in neonates: analysis of five cases. Acta Gastroenterol Belg 66:271–273PubMedGoogle Scholar

Copyright information

© Association of Surgeons of India 2016

Authors and Affiliations

  • Mehmet Saraç
    • 1
    Email author
  • Ünal Bakal
    • 1
  • Mustafa Aydın
    • 2
  • Tugay Tartar
    • 1
  • Aysen Orman
    • 2
  • Erdal Taşkın
    • 2
  • Şenay Canpolat
    • 1
  • Ahmet Kazez
    • 1
  1. 1.Department of Pediatric SurgeryFirat University School of MedicineElazigTurkey
  2. 2.Department of NeonatologyFirat University Medical FacultyElazigTurkey

Personalised recommendations