Gastrointestinal perforations in neonatal surgery

From 1970 until 1987 we treated 69 newborns with gastro-intestinal perforations. Immediate measures in form of laparotomy were undoubtedly necessary. Regarding our casuistic the authors present the clinical findings, necessary preoperative diagnostic measures and intra-operative and postoperative treatment. The localisation and the origin of the perforation are pointed out. The most frequent localisation was the small bowel (58%), followed by the colon (35%). Etiologically we found extensive NEC, atresias, meconium ileus and Hirschsprung's disease. In 4 cases iatrogenic rectum perforations, in 3 cases spontaneous gastric and duodenal perforations and twice an appendicular perforation were seen. Our operative procedure depends on the localisation, the degree of peritonitis, on intestinal necrosis and trophic alterations of the gut following ileus. In spite of intensive care, the mortality rate is still very high indicated with 33%. Furthermore more than half premature newborns died (18 out of 33). Based on these facts we propose quick diagnostic measures, interdisciplinary cooperation, an emergency operation followed by intensive care to ameliorate the results. Nevertheless we must keep in mind that newborns, who some years ago were condemned to die, nowadays can be operated, thus changing the mortality of gastro-intestinal perforations.