P470 Spontaneous intestinal perforation in an extremely low birth weight infant: a case report

Spontaneous intestinal perforation(SIP) usually occurs in the first 10 days of life primarily in preterm infants with very low birth weight (VLBW) and extremely low birth weight (ELBW). The risk is 2–3% and 5% in VLBW infants and ELBW infants, respectively. Herein, we present a case of a 410 g female infant born at 25 weeks of gestational age who developed SIP on the 7th postnatal day. The patient was born by emergent cesarean delivery after the diagnosis of chorioamnionitis in the mother. She was intubated in the delivery room due to insufficient respiratory effort and surfactant was administered. The infant was admitted to the neonatal intensive care unit (NICU) and she was mechanically ventilated in SIMV mode. Her chest×ray was compatible with respiratory syndrome. A venous umbilical catheter was placed, parenteral nutrition was initiated. Minimal enteral nutrition (MEN)was started on 3rd day of life with mother’s own milk (1 ml every 6 hour). She was tolerating MEN and no increment was done in the amount of milk. Until the postnatal 6th day no abdominal distension or any intolerance of MEN was detected. On postnatal 7th day there was a bluish discoloration of the abdominal wall and abdominal distension was detected. In abdominal×ray, free air under the diaphragm was detected suggestive of perforation. She was an ELBW infant in the first week of life with bluish discoloration and distention of the abdomen without any radiographic evidence of NEC as pneumatosis intestinalis or portal venous gas on the abdominal×ray. Therefore, diagnosis of SIP rather than NEC was made. The primary peritoneal drainage (PPD) was performed at the bedside due to the unstable condition of the patient. She was started inotropic support due to development of hypotension and IV antibiotic therapy was changed. Despite all the supportive therapy, the patient died on the 8th postnatal day. Severe placental chorioamnionitis appears to be an antenatal risk factor for SIP. A black-bluish discoloration of the abdominal wall is often seen in SIP, and is not typical of NEC. The clinical diagnosis for SIP is based upon the clinical presentation and physical findings. Abdominal radiographs that demonstrate pneumoperitoneum without pneumatosis are supportive of the diagnosis. SIP is a separate clinical entity from necrotizing enterocolitis and it is the most severe gastrointestinal complication of preterm infants. Therefore, prompt diagnosis is important because of management considerations.