The role of peritoneal drainage for intestinal perforation in infants withand without necrotizing enterocolitis

Background/Purpose: This report reviews our experience using peritoneal dra inage (PD) as initial therapy for intestinal perforation in premature infan ts with and without necrotizing enterocolitis (NEC). Methods: A chart review was conducted of 18 consecutive premature infants w ho underwent PD for intestinal perforation from 1995 to 1998. Infants were divided into two groups. Group 1 consisted of eight infants who had intesti nal perforation without evidence of NEC. Group 2 consisted of 10 infants wh o had perforation associated with evidence of NEC. A cohort of 10 infants w ith intestinal perforation treated with primary laparotomy between 1990 and 1995 was identified by chart review for historical control. Results: All infants improved immediately after PD. In group 1, all survive d. Seven (88%) recovered systemically after PD. Of these, five (63%) never required laparotomy. Two (25%) required delayed laparotomy. One infant (12% ) failed to continue to improve 48 hours after PD and underwent urgent lapa rotomy and recovered. In group 2, eight (80%) infants survived. Six (60%) r ecovered from NEC after PD, but five required delayed laparotomy for obstru ction or persistent drainage. Four infants (40%) failed to progress from th eir initial improvement after PD. Three underwent laparotomy; two recovered and one had total intestinal necrosis and died. The fourth infant died wit hout exploration and total intestinal necrosis was discovered during autops y. Thus, seven of eight survivors (88%) in group 2 required laparotomy at s ome point in their course. Conclusions In premature infants with intestinal perforation, PD allows acu te improvement and usually systemic recovery. In infants without evidence o f NEC, PD may afford definitive treatment. In contrast, infants with eviden ce of NEC will likely require laparotomy, but initial PD may allow systemic stabilization and recovery of much of the involved intestine before laparo tomy. J Pediatr Surg 34: 143-147. Copyright (C) 1999 by W.B. Saunders Compa ny.