PERINATOLOGIYA I PEDIATRIYA.2013.3(55):66–69;doi10.15574/PP.2013.55.66

Pathogenesis, clinical and morphological features of gastro-intestinal perforations in newborns

Shatrova K. M., Gorbatyuk O. M., Martynyuk T. V.

P.L.Shupik National Medical Academy of Postgraduate Education, Kiev, Ukraine

Volyn' Regional Territorial Medical Association, Lutsk, Ukraine

The aim the study was to investigate risk factors, pathogenetic mechanism and morphological features of gastrointestinal perforations in newborns; to determinate main differences between spontaneous perforations and perforations followed by ulcerative necrotizing enterocolitis (NNEC) and optimization of preventive, therapeutic and surgical arrangements.

Patients and methods. 59 newborns with spontaneous gastrointestinal perforations and perforations against the background of UNEC were investigated. Clinical, laboratory, instrumental and X-ray examination were held. An operational and sectional material was a subject of the study. Paraffin embedded sections were stained with hematoxylin and eosin and picrofuchsin after Van Gieson. Histology and pictures were made by «Ahio Imager 2» from Carl Zeiss.

Results. Reasons and morphogenesis of gastrointestinal perforations in newborns were elucidated. The authors identified clinical and morphological differences between UNEC and spontaneous gastrointestinal perforations. Main links of UNEC pathogenesis are: increase of blood flow vascular resistance in uterine-placental and fetal-placental circulatory systems; decrease of intestinal blood supply by prenatal prolonged fetal hypoxia, ischemic and reperfusion damages of ileum mucosa following by enteral nourishing. Additional risk factor is tissue defect (vascular-muscular dysplasia, seldom — ectopia), that spring up because of influence of adverse factors in embryonic stage of gastrointestinal perforations in newborns is a basis for right therapeutical tactics and selection of the surgical treatment form.

Conclusions. Morphogenesis of the gastrointestinal perforations in the newborn is the basis for assigning the correct treatment strategy and determination of the type of surgery.

Key words: newborns, intestinal perforations, necrotizing enterocolitis, isolated perforations, morphological study.

REFERENCES

1. Арапова АВ, Ольхова ЕБ, Щитинин ВЕ. 2003. Язвенно-некротический энтероколит у новорожденных. Детская хирургия. 1: 11—15.

2. Баиров ВГ, Немилова ТК, Караваева СА. 1998. Некротический энтероколит как проблема хирургической неонатологии: 19-летний опыт лечения. Матер ІІ Междунар Конгресса Северных стран и регионов. Кондопога: 74—75.

3. Гассан ТА. 2002. О проблеме кишечных стом у детей периода новорожденности. Детская хирургия. 4: 41—43.

4. Караваева СА. 2002. Диагностика и особенности клинического течения некротического энтероколита у детей. Вестник хирургии им. Грекова. 161;4: 41—44.

5. Тимофеев ДВ. 2005. Факторы риска и лечения перфораций желудочно-кишечного тракта у новорожденных. Автореф. дис. канд. мед. наук. 14.00.27. Иркутск: 24.

6. Geryk B, Kerdikova M. 1984. Spontaneous perforation of the duodenum in a newborn infant. Rozhl. Chir. 63;11: 741—743.

7. Leone RS, Krasna IH. 2000. Spontaneous neonatal gastric perforation: is it really spontaneous? J. Pediatr. Surg. 35;7: 1066—1069.

8. Mintz AS, Applebaum H. 1993. Focal gastrointestinal perforations not associated with necrotizing enterocolitis in very low birth weight neonates. J. Pediatr. Surg. 28;6: 857—860.

9. Izraeli S, Freud E, Mor C, Litwin A et al. 1992. Neonatal intestinal perforation due to congenital defects in the intestinal muscularis. Eur. J. Pediatr. 151;4: 300—303.

10. Husain AN, Hong HY, Goonneratne S, Muraskas J. et al. 1992. Segmental absence of small intestinal musculature. Pediatr. Pathol. 12;3: 407—415.