Peritoneal drainage in spontaneous intestinal perforation: a 20-year single center review.

PURPOSE: Spontaneous intestinal perforation (SIP) is a morbid condition of low-birth-weight neonates. Peritoneal drainage (PD), as opposed to upfront laparotomy (LP), is favored for SIP. However, PD management is neither standardized nor thoroughly understood. We reviewed our experience of PD in infants with SIP.

METHODS

Neonates treated for SIP between 07/2004 and 03/2023 were reviewed. Patients with NEC or death immediately following PD were excluded. Patients treated with a PD that required LP within 30 days were considered salvage laparotomy (SL).

RESULTS

A total of 235 neonates were included. The median gestational age and birth weight were 25.0 weeks (IQR: 24.1, 26.3) and 720 g (IQR: 620, 865). Ninety-three (39.6%) patients required SL at a median of 9 days (IQR: 5, 14) from PD. Indications for failure included recurrent pneumoperitoneum (52%), clinical deterioration (20%), and ongoing feculent drain output (14%). At SL, 8.4% of patients were found to have NEC. SL patients had extended length of stay: 113 days (IQR: 86, 153) vs. 67 days (IQR: 38, 115), p < 0.001.

CONCLUSION

PD is an important tool in the management of SIP, however SL is not uncommon (39%) and has clinical significance. Prospective data to improve PD management is needed.