GASTROINTESTINAL PERFORATIONS IN INFANCY

ANATOMIC AND ETIOLOGIC GAMUTS

Over a 22 year period, 53 infants under 1 year of age suffered gastrointestinal perforations. Seventy-two per cent of these took place during the first week of life.

Predisposing factors have been found to range widely through the following general categories: metabolic, genetic, inflammatory, mechanical, and unexplained. Twentytwo of the babies were born prematurely.

Sixteen perforations were iatrogenic. Of these, 11 followed a variety of surgical procedures, 1 developed subsequent to transfusion, and 4 resulted during or after barium enema examinations.

The anatomic distribution showed the stomach, the small intestine, and the colon each accounting for between 23 and 30 per cent of the total. Perforations of esophagus and duodenum were much less frequent, 3 each. In 5 patients a site of perforation was not identified.

Twenty-six of the patients survived— an incidence of 49 per cent. The highest survival was in stomach perforations, 9 out of 12 (75 per cent). None of the 3 infants with duodenal perforation lived. Constant vigilance is required, of clinician and radiologist, to be on the lookout for the earliest signs of gastrointestinal perforation. The patient’s best hope for survival lies in prompt diagnosis and treatment.

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