Surgical Tactics in Perforations of Stomach and Small Intestine in Children (Literature Review)

Abstract

INTRODUCTION: Currently, the number of pediatric patients urgently hospitalized with different variants of gastrointestinal perforations complicated with peritonitis, remains high. In the given work, the variants of the surgical treatment depending on the location of the perforation defect (stomach, duodenum, small intestine) are presented, and the most common causes of such conditions encountered in clinical practice, are described (perforation of Meckel’s diverticulum, spontaneous perforation of small intestine and stomach in children with extremely low body mass, patients with Ehlers–Danlos syndrome).

AIM: To determine the most relevant variants of surgical tactics in children with perforations of different parts of the gastrointestinal tract (in particular, stomach, small intestine) in conditions of peritonitis.

MATERIALS AND METHODS: In the process of studying the literature, 142 scientific publications were analyzed on Google Academy, PubMed, eLIBRARY information resources, published from 2002 to 2022. With this, works describing intestinal perforation with the underlying necrotic enterocolitis, were excluded from the study, since this category of patients requires a separate discussion and description of approaches to treatment.

CONCLUSION: According to the results of the analysis of scientific literature, variants of surgical tactics used in perforations of the gastric wall include (in the order from the most commonly used to the least common): laparotomy and suturing with excision of the edges of the defect; suturing in conditions of laparoscopy; atypical resection with the formation of a gastric ‘tube’ on the probe; resection of stomach. In duodenal perforations, the following methods are used: rhomboid duodeno-duodenoanastomosis according to Kimura, intracorporeal suture with endovideosurgical access; laparotomy and suturing of the defect in extensive necrosis. In spontaneous perforation in the small intestine, resection of the part of the intestine is advisable — anastomosis according to Santulli in combination with terminal ileostomy, simultaneous end-to-end anastomosis or application of intestinal stomas.

Keywords

stomach / small intestine / children / peritonitis / perforation / laparotomy / laparoscopy

References

[1] Kucherov YI, Zhirkova YV, Shishkina TN, et al. Malformations of Intestine in Premature Infants under the Mask of Necrotizing Enterocolitis. Voprosy Sovremennoj Pediatrii. 2015;14(2):300–4. (In Russ). doi: 10.15690/vsp.v14i2.1303

[2] Кучеров Ю.И., Жиркова Ю.В., Шишкина Т.Н., и др. Пороки развития кишечника у недоношенных, протекающие под маской некротического энтероколита // Вопросы современной педиатрии. 2015. Т. 14, № 2. С. 300–304. doi: 10.15690/vsp.v14i2.1303

[3] Adamou H, Habou O, Amadou–Magagi I, et al. Non-traumatic acute peritonitis in children: causes and prognosis in 226 patients at the National Hospital of Zinder, Niger. Med Sante Trop. 2017;27(3):264–9. doi: 10.1684/mst.2017.0692

[4] Adamou H., Habou O., Amadou–Magagi I., et al. Non-traumatic acute peritonitis in children: causes and prognosis in 226 patients at the National Hospital of Zinder, Niger // Med. Sante Trop. 2017. Vol. 27, No. 3. P. 264–269. doi: 10.1684/mst.2017.0692

[5] Vasuki R, Arun PS, Moothedath RM. A rare case of spontaneous gastric perforation in an adolescent. Int Surg J. 2018;5(9):3171–4. doi: 10.18203/2349-2902.isj20183743

[6] Vasuki R., Arun P.S., Moothedath R.M. A rare case of spontaneous gastric perforation in an adolescent // Int. Surg. J. 2018. Vol. 5, No. 9. P. 3171–3174. doi: 10.18203/2349-2902.isj20183743

[7] Kulkarni K, Tiwari Ch, Nagdeve N, et al. Spontaneous pre-pyloric perforation in children. Pediatr Oncall J. 2019;16(4):115–8. doi: 10.7199/ped.oncall.2019.35

[8] Kulkarni K., Tiwari Ch., Nagdeve N., et al. Spontaneous pre-pyloric perforation in children // Pediatr. Oncall J. 2019. Vol. 16, No. 4. P. 115–118. doi: 10.7199/ped.oncall.2019.35

[9] Goyal S, Garg A, Goyal S. Peptic perforation in children: a diagnostic dilemma. J Med Res. 2017;3(2):57–9. doi: 10.31254/jmr.2017.3206

[10] Goyal S., Garg A., Goyal S. Peptic perforation in children: a diagnostic dilemma // J. Med. Res. 2017. Vol. 3, No. 2. P. 57–59. doi: 10.31254/jmr.2017.3206

[11] Khadjibaev AM, Pulatov DT, Tilemisov SO. «Furacilin test» in the diagnosis of covered perforated ulcers of the stomach and duodenum. The Bulletin of Emergency Medicine. 2018;11(2):5–8. (In Russ).

[12] Хаджибаев А.М., Пулатов Д.Т., Тилемисов С.О. «Фурацилиновая проба» при диагностике прикрытых перфоративных язв желудка и двенадцатиперстной кишки // Вестник экстренной медицины. 2018. Т. 11, № 2. С. 5–8.

[13] Styazhkina SN, Pelina NA, Sitnikov VA, et al. Klinicheskiy sluchay. Variant taktiki pri travme dvenadtsatiperstnoy kishki. Dostizheniya Nauki i Obrazovaniya. 2018;(18):80–2. (In Russ).

[14] Стяжкина С.Н., Пелина Н.А., Ситников В.А., и др. Клинический случай. Вариант тактики при травме двенадцатиперстной кишки // Достижения науки и образования. 2018. № 18 (40). С. 80–82.

[15] Zarate–Suarez LA, Urquiza–Suárez YL, García CF, et al. Acute abdomen and perforated duodenal ulcer in an adolescent: case report. Revista de la Facultad de Medicina. 2018;66(2):279–81. doi: 10.15446/revfacmed.v66n2.59798

[16] Zarate–Suarez L.A., Urquiza–Suárez Y.L., García C.F., et al. Acute abdomen and perforated duodenal ulcer in an adolescent: case report // Revista de la Facultad de Medicina. 2018. Vol. 66, No. 2. P. 279–281. doi: 10.15446/revfacmed.v66n2.59798

[17] Yang T, Huang Y, Li J, et al. Neonatal gastric perforation: case series and literature review. World J Surg. 2018;42(8):2668–73. doi: 10.1007/s00268-018-4509-x

[18] Yang T., Huang Y., Li J., et al. Neonatal gastric perforation: case series and literature review // World J. Surg. 2018. Vol. 42, No. 8. P. 2668–2673. doi: 10.1007/s00268-018-4509-x

[19] Karavaeva SA, Podkamenev AV, Skopetc AA. Necrosis and perforation of the stomach in newborn babies and infants. Grekov's Bulletin of Surgery. 2020;179(5):36–40. (In Russ). doi: 10.24884/0042-4625-2020-179-5-36-40

[20] Караваева С.А., Подкамнев А.В., Скопец А.А. Некроз и перфорации желудка у новорождённых и детей раннего возраста // Вестник хирургии имени И.И. Грекова. 2020. Т. 179, № 5. С. 36–40. doi: 10.24884/0042-4625-2020-179-5-36-40

[21] Bidaibayev AN, Yelubayev ZK, Akmoldayev YA, et al. Analysis of the problem of stomach perforations in newborns in the Karaganda region. Medicine and Ecology. 2020;(2):57–66. (In Russ).

[22] Бидайбаев А.Н., Елубаев Ж.К., Акмолдаев Е.А., и др. Анализ проблемы перфораций желудка у новорожденных в Карагандинской области // Медицина и экология. 2020. № 2. С. 57–66.

[23] Skopetс AA, Karavaeva SA, Nemilova TK. Long-term results of treatment of newborns and infants with necrosis and perforation of the stomach and duo-denum. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(1):7–16. (In Russ). doi: 10.17816/psaic718

[24] Скопец А.А., Караваева С.А., Немилова Т.К. Отдаленные результаты лечения новорожденных и детей грудного возраста с некрозом и перфорацией желудка и двенадцатиперстной кишки // Российский вестник детской хирургии, анестезиологии и реаниматологии. 2021. Т. 11, № 1. С. 7–16. doi: 10.17816/psaic718

[25] Kozlov YuA, Rasputin AA, Baradieva PJ, et al. Surgical treatment of neonates with gastric perforation. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(1):47–56. (In Russ). doi: 10.30946/2219-4061-2019-9-1-47-56

[26] Козлов Ю.А., Распутин А.А., Барадиева П.Ж., и др. Хирургическое лечение новорожденных с перфорацией желудка // Российский вестник детской хирургии, анестезиологии и реаниматологии. 2019. Т. 9, № 1. С. 47–56. doi: 10.30946/2219-4061-2019-9-1-47-56

[27] Akilov HA, Urmanov NT, Khodjayarov NR. Treatment of children with perforated ulcers of the stomach and duodenum in Tashkent. Russian Journal of Pediatric Surgery. 2020;24(1):53–6. (In Russ). doi: 10.18821/1560-9510-2020-24-1-53-56

[28] Акилов Х.А., Урманов Н.Т., Ходжаяров Н.Р. Опыт лечения детей с перфоративными язвами желудка и двенадцатиперстной кишки в Ташкенте // Детская хирургия. Журнал им. Ю.Ф. Исакова. 2020. Т. 24, № 1. С. 53–56. doi: 10.18821/1560-9510-2020-24-1-53-56

[29] Zaporozhchenko AG, Gladky AP, Dovbysh OV, et al. Features of clinical course of perforated ulcers of stomach and duodenum in children. Zdorov’ye Rebenka. 2013;(8):121–4. (In Russ).

[30] Запорожченко А.Г., Гладкий А.П., Довбыш О.В., и др. Особенности клинического течения перфоративных язв желудка и двенадцатиперстной кишки у детей // Здоровье ребенка. 2013. № 8 (51). С. 121–124.

[31] Amanova MA, Smirnov AN, Kholostova VV, et al. Spontaneous perforation of the stomach and duodenum in children with Ehlers– Danlos syndrome. Experimental and Clinical Gastroenterology. 2021; 185(1):176–82. (In Russ). doi: 10.31146/1682-8658-ecg-185-1-176-182

[32] Аманова М.А., Смирнов А.Н., Холостова В.В., и др. Спонтанные перфорации желудка и 12-перстной кишки у детей с синдромом Элерса– Данлоса // Экспериментальная и клиническая гастроэнтерология. 2021. Т. 1, № 1. С. 176–182. doi: 10.31146/1682-8658-ecg-185-1-176-182

[33] Gisak SN, Sklyarova EA, Vecherkin VA, et al. Modern causative pathogens of peritonitis in cases of the perforation of the stomach, small intestine or colon in children and optimization of the differentiated treatment of patients. Russian Journal of Pediatric Surgery. 2018;22(2):65–72. (In Russ). doi: 10.18821/1560-9510-2018-22-2-65-72

[34] Гисак С.Н., Склярова Е.А., Вечеркин В.А., и др. Современные возбудители гнойного перитонита при перфорации желудка, тонкой или толстой кишки у детей и оптимизация дифференцированного лечения больных // Детская хирургия. Журнал им. Ю.Ф. Исакова. 2018. Т. 22, № 2. С. 65–72. doi: 10.18821/1560-9510-2018-22-2-65-72

[35] Sokolov YuYu, Korovin SA, Tumanyan GT, et al. Surgical treatment of children with perforated gastric and duodenal ulcers. Russian Journal of Pediatric Surgery. 2017;21(1):10–4. (In Russ).

[36] Соколов Ю.Ю., Коровин С.А., Туманян Г.Т., и др. Хирургическое лечение детей с перфоративными язвами желудка и двенадцатиперстной кишки // Детская хирургия. Журнал им. Ю.Ф. Исакова. 2017. Т. 21, № 1. С. 10–14.

[37] Skopec AA. Duodenal perforation in newborns and young children. Russian Pediatric Journal. 2019;22(5):318. (In Russ).

[38] Скопец А.А. Перфорация двенадцатиперстной кишки у новорожденных и детей раннего возраста // Российский педиатрический журнал. 2019. Т. 22, № 5. С. 318.

[39] Pritulo LF, Peylivanov FP, Goncov SV, et al. Our experience in treating congenital malformations of duodenum in children. Tavricheskiy Mediko-Biologicheskiy Vestnik. 2018;21(1):124–30. (In Russ).

[40] Притуло Л.Ф., Пейливанов Ф.П., Гонцов С.В., и др. Наш опыт лечения пороков развития двенадцатиперстной кишки у детей // Таврический медико-биологический вестник. 2018. Т. 21, № 1. С. 124–130.

[41] Hattingh G, Salas–Parra RD, Nuzhad A, et al. Duodenal perforation in the pediatric population: two rare cases at a small community hospital. J Surg Case Rep. 2020;2020(11):rjaa455. doi: 10.1093/jscr/rjaa455

[42] Hattingh G., Salas–Parra R.D., Nuzhad A., et al. Duodenal perforation in the pediatric population: two rare cases at a small community hospital // J. Surg. Case Rep. 2020. Vol. 2020, No. 11. P. rjaa455. doi: 10.1093/jscr/rjaa455

[43] Yan X, Kuang H, Zhu Z, et al. Gastroduodenal perforation in the pediatric population: a retrospective analysis of 20 cases. Pediatr Surg Int. 2019;35(4):473–7. doi: 10.1007/s00383-018-4420-4

[44] Yan X., Kuang H., Zhu Z., et al. Gastroduodenal perforation in the pediatric population: a retrospective analysis of 20 cases // Pediatr. Surg. Int. 2019. Vol. 35, No. 4. P. 473–477. doi: 10.1007/s00383-018-4420-4

[45] Shatrova KM, Gorbatyuk OM, Martinyuk TV. Pathogenesis, clinical and morphological features of gastro intestinal perforations in newborns. Perinatologiya i Pediatriya. 2013;(3):66–9. (In Russ).

[46] Шатрова К.М., Горбатюк О.М., Мартинюк Т.В. Патогенез и клинико- морфологические особенности перфораций желудочно-кишечного тракта у новорожденных // Перинатология и педиатрия. 2013. № 3 (55). С. 66–69.

[47] Belotserkovtseva LD, Kovalenko LV, Prisukha IN, et al. Optimization of surgical aid for bowel obstruction in premature infants with extremely low birth weight. Vestnik SurGU. Meditsina. 2017;(1):27–30. (In Russ).

[48] Белоцерковцева Л.Д., Коваленко Л.В., Присуха И.Н., и др. Оптимизация хирургической помощи при обструкции кишечника н едоношенным детям с экстремально низкой массой тела при рождении // Вестник СурГУ. Медицина. 2017. № 1 (31). С. 27–30.

[49] Gordon PV, Attridge JT. Understanding clinical literature relevant to spontaneous intestinal perforations. Am J Perinatol. 2009;26(4):309–16. doi: 10.1055/s-0028-1103514

[50] Gordon P.V., Attridge J.T. Understanding clinical literature relevant to spontaneous intestinal perforations // Am. J. Perinatol. 2009. Vol. 26, No. 4. P. 309–316. doi: 10.1055/s-0028-1103514

[51] Rai BK, Alam MDS, Sah C, et al. Duodenal ulcer perforation in pediatric population: a rare entity. Medphoenix. 2020;5(1):79–81. doi: 10.3126/medphoenix.v5i1.31425

[52] Rai B.K., Alam M.D.S., Sah C., et al. Duodenal ulcer perforation in pediatric population: A rare entity // Medphoenix. 2020. Vol. 5, No. 1. P. 79–81. doi: 10.3126/medphoenix.v5i1.31425

[53] Swanson JR, Hair A, Clark RH, et al. Spontaneous intestinal perforation (SIP) will soon become the most common form of surgical bowel disease in the extremely low birth weight (ELBW) infant. J Perinatol. 2022;42(4):423–9. doi: 10.1038/s41372-022-01347-z

[54] Swanson J.R., Hair A., Clark R.H., et al. Spontaneous intestinal perforation (SIP) will soon become the most common form of surgical bowel disease in the extremely low birth weight (ELBW) infant // J. Perinatol. 2022. Vol. 42, No. 4. P. 423–429. doi: 10.1038/s41372-022-01347-z

[55] Ignatev EM, Efremenkov AM, Trunova RB, et al. Case of multiple acute small bowel perforations in a child aged 9 months old. Russian Journal of Pediatric Surgery. 2018;22(1):52–4. (In Russ). doi: 10.18821/1560-9510-2018-22-1-52-54

[56] Игнатьев Е.М., Ефременков А.М., Трунова Р.Б., и др. Случай множественных острых перфораций тонкой кишки у ребёнка 9 месяцев // Детская хирургия. Журнал им. Ю.Ф. Исакова. 2018. Т. 22, № 1. С. 52–54. doi: 10.18821/1560-9510-2018-22-1-52-54

[57] Park KY, Gill KG, Kohler JE. Intestinal perforation in children as an important differential diagnosis of vascular Ehlers-Danlos syndrome. Am J Case Rep. 2019;20:1057–62. doI: 10.12659/ajcr.917245

[58] Park K.Y., Gill K.G., Kohler J.E. Intestinal perforation in children as an important differential diagnosis of vascular Ehlers–Danlos syndrome // Am. J. Case Rep. 2019. Vol. 20. P. 1057–1062. doI: 10.12659/ajcr.917245

[59] Gorbatyuk OM, Martynyuk TV, Shatrova KM. Clinical and morphological characteristics the gastrointestinal perforation in newborn. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2013;3(2): 31–6. (In Russ).

[60] Горбатюк О.М., Мартынюк Т.В., Шатрова К.М. Клинико-морфологические характеристики желудочно-кишечных перфораций у новорожденных // Российский вестник детской хирургии, анестезиологии и реаниматологии. 2013. Т. 3, № 2. С. 31–36.

[61] Belotserkovtseva LD, Kovalenko LV, Prisukha IN. Results of premature infants treatment with spontaneous intestinal perforation and ileal dilatation, preceding abdominal catastrophe. Vestnik SurGU. Meditsina. 2018;(2):29–36. (In Russ).

[62] Белоцерковцева Л.Д., Коваленко Л.В., Присуха И.Н. Результаты лечения недоношенных новорожденных детей при спонтанной перфорации кишечника и при дилатации подвздошной кишки, предшествующей катастрофе в брюшной полости // Вестник СурГУ. Медицина. 2018. № 2 (36). С. 29–36.

[63] Gorbatyuk OM, Martynyuk TV, Shatrova KM. Differences in gastrointestinal perforations in newborn infants based on clinical and morphological data. Russian Journal of Pediatric Surgery. 2014;18(2):4–7. (In Russ).

[64] Горбатюк О.М., Мартынюк Т.В., Шатрова К.М. Отличия желудочно- кишечных перфораций у новорожденных детей по клиническим и морфологическим данным // Детская хирургия. Журнал им. Ю.Ф. Исакова. 2014. Т. 18, № 2. С. 4–7.

[65] Ara C, Coban S, Kayaalp C, et al. Spontaneous intestinal perforation due to non-Hodgkin's lymphoma: evaluation of eight cases. Dig Dis Sci. 2007;52(8):1752–6. doI: 10.1007/s10620-006-9279-x

[66] Ara C., Coban S., Kayaalp C., et al. Spontaneous intestinal perforation due to non-Hodgkin's lymphoma: evaluation of eight cases // Dig. Dis. Sci. 2007. Vol. 52, No. 8. P. 1752–1756. doI: 10.1007/s10620-006-9279-x

[67] Pumberger W, Mayr M, Kohlhauser C, et al. Spontaneous localized intestinal perforation in very-low-birth-weight infants: a distinct clinical entity different from necrotizing enterocolitis. J Am Coll Surg. 2002;195(6):796–803. doi: 10.1016/s1072-7515(02)01344-3

[68] Pumberger W., Mayr M., Kohlhauser C., et al. Spontaneous localized intestinal perforation in very-low-birth-weight infants: a distinct clinical entity different from necrotizing enterocolitis // J. Am. Coll. Surgeons. 2002. Vol. 195, No. 6. P. 796–803. doi: 10.1016/s1072-7515(02)01344-3

[69] Prisukha IN, Belotserkovtseva LD, Akselrov MA. Stratification of risk factors for intestinal perforation in premature infants and their influence on the choice of the moment of surgical intervention. Pediatrics. Journal named after G.N. Speransky. 2019;98(6):65–70. (In Russ).

[70] Присуха И.Н., Белоцерковцева Л.Д., Аксельров М.А. Стратификация факторов риска перфорации кишечника у недоношенных детей и их влияние на выбор момента хирургического вмешательства // Педиатрия. Журнал имени Г.Н. Сперанского. 2019. Т. 98, № 6. С. 65–70.

[71] Zamir O, Goldberg M, Udassin R, et al. Idiopathic gastrointestinal perforation in the neonate. J Pediatr Surg. 1988;23(4):335–7. doi: 10.1016/s0022-3468(88)80201-x

[72] Zamir O., Goldberg M., Udassin R., et al. Idiopathic gastrointestinal perforation in the neonate // J. Pediatr. Surg. 1988. Vol. 23, No. 4. P. 335–337. doi: 10.1016/s0022-3468(88)80201-x

[73] Hansen C–C, Søreide K. Systematic review of epidemiology, presentation, and management of Meckel's diverticulum in the 21st century. Medicine. 2018;97(35):e12154. doi: 10.1097/md.0000000000012154

[74] Hansen C.–C., Søreide K. Systematic review of epidemiology, presentation, and management of Meckel's diverticulum in the 21st century // Medicine. 2018. Vol. 97, No. 35. P. e12154. doi: 10.1097/md.0000000000012154

[75] Shyla RS, Mahiliavets EV, Belyuk KS, et al. Complications of small intestine diverticula, cases from clinical practice. Journal of the Grodno State Medical University. 2019;17(2):219–23. (In Russ). doi: 10.25298/2221-8785-2019-17-2-219-223

[76] Шило Р.С., Могилевец Э.В., Белюк К.С., и др. Осложнения дивертикулов тонкой кишки, случаи из практики // Журнал Гродненского государственного медицинского университета. 2019. Т. 17, № 2. С. 219–223. doi: 10.25298/2221-8785-2019-17-2-219-223

[77] Kozlov YuA, Novozhilov VA, Timofeev AD. Spontaneous perforation of the intestine in prematurely born children. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):102–8. (In Russ).

[78] Козлов Ю.А., Новожилов В.А., Тимофеев А.Д. Спонтанная перфорация кишечника у недоношенных детей // Российский вестник детской хирургии, анестезиологии и реаниматологии. 2016. Т. 6, № 4. С. 102–110.

[79] Kozlov YuA, Novozhilov VA, Koval'kov KA, et al. Results of the treatment of spontaneous intestinal perforation in preterm children. Russian Journal of Pediatric Surgery. 2017;21(6):284–9. (In Russ).

[80] Козлов Ю.А., Новожилов В.А., Ковальков К.А., и др. Результаты лечения спонтанной перфорации кишечника у недоношенных детей // Детская хирургия. Журнал им. Ю.Ф. Исакова. 2017. Т. 21, № 6. С. 284–289.

RIGHTS & PERMISSIONS

Eco-Vector