İntrauterin İntestinal Perforasyon
Özet
İntrauterin intestinal perforasyon yenidoğan döneminde ciddi morbidite ve mortaliteye neden olabilen nadir cerrahi patolojilerden biridir. Prenatal ultrasonografi, neonatal yoğun bakım uygulamaları ve cerrahi tedavideki gelişmeler sayesinde son yıllarda sağkalım oranları belirgin şekilde artmıştır. Bu çalışmada prenatal dönemde progresif bağırsak dilatasyonu saptanan, doğum sonrası ileri abdominal distansiyon ve safralı nazogastrik drenaj ile prezente olan kompleks intrauterin intestinal perforasyon olgusu sunuldu. Cerrahi eksplorasyonda intestinal içerik ile dolu psödokist, yoğun fibroadezif inflamasyon, komplike mekonyum peritoniti ve intestinal segmental volvulus mevcuttu. Malrotasyon saptanmadı. Adezyolizis, proksimal ileostomi, distal ileal anastomoz ve drenaj uygulandı. Postoperatif dönemde yüksek debili stoma, uzun süre total parenteral nütrisyon gereksinimi ve kateter ilişkili enfeksiyonlar gelişti. Bu olgu intrauterin intestinal perforasyonlarda aşamalı cerrahi yaklaşımın ve multidisipliner postoperatif bakımın önemini göstermektedir.
Referanslar
Nam SH, Kim SC, Kim DY, et al. Experience with meconium peritonitis. J Pediatr Surg. 2007 Nov;42(11):1822–5. doi:10.1016/j.jpedsurg.2007.07.006 PubMed PMID: 18022430.
Zangheri G, Andreani M, Ciriello E, et al. Fetal intra-abdominal calcifications from meconium peritonitis: sonographic predictors of postnatal surgery. Prenat Diagn. 2007 Oct;27(10):960–3. doi:10.1002/pd.1812 PubMed PMID: 17654754.
Foster MA, Nyberg DA, Mahony BS, et al. Meconium peritonitis: prenatal sonographic findings and their clinical significance. Radiology. 1987 Dec;165(3):661–5. doi:10.1148/radiology.165.3.3317498 PubMed PMID: 3317498.
Montironi R, Tosto V, Quintili D, et al. Antenatal Diagnosis and Management of Fetal Intestinal Volvulus: Case Series and Literature Review. J Clin Med. 2023 Jul 20;12(14):4790. doi:10.3390/jcm12144790 PubMed PMID: 37510904; PubMed Central PMCID: PMC10381374.
Takacs ZF, Meier CM, Solomayer EF, et al. Prenatal diagnosis and management of an intestinal volvulus with meconium ileus and peritonitis. Arch Gynecol Obstet. 2014 Aug;290(2):385–7. doi:10.1007/s00404-014-3223-7 PubMed PMID: 24682585.
Chan KL, Tang MHY, Tse HY, et al. Meconium peritonitis: prenatal diagnosis, postnatal management and outcome. Prenat Diagn. 2005 Aug;25(8):676–82. doi:10.1002/pd.1221 PubMed PMID: 16049997.
Niramis R, Watanatittan S, Anuntakosol M, et al. Meconium peritonitis. J Med Assoc Thail Chotmaihet Thangphaet. 1999 Nov;82(11):1063–70. PubMed PMID: 10659538.
Ayvaz OD, Cansaran S, Celayir A, et al. Twelve years of experience in the treatment of newborns with intrauterine gastrointestinal perforation. Turk J Pediatr. 2023 Jun 25;65(3):387–97. doi:10.24953/turkjped.2022.748
Wong CWY, Wong KKY. Meconium peritonitis: A 22-year review in a tertiary referral center. J Pediatr Surg. 2022 Aug;57(8):1504–8. doi:10.1016/j.jpedsurg.2021.10.006 PubMed PMID: 34794810.
Stringer M, Spitz L. Surgical management of neonatal necrotizing enterocolitis. Arch Dis Child. 1993 Oct 1;69:269–71. doi:10.1136/adc.69.3_Spec_No.269
Modi BP, Galloway DP, Gura K, et al. ASPEN definitions in pediatric intestinal failure. JPEN J Parenter Enteral Nutr. 2022 Jan;46(1):42–59. doi:10.1002/jpen.2232 PubMed PMID: 34287974.
Duggan CP, Jaksic T. Pediatric Intestinal Failure. N Engl J Med. 2017 Aug 17;377(7):666–75. doi:10.1056/NEJMra1602650 PubMed PMID: 28813225.
Modi BP, Langer M, Ching YA, et al. Improved survival in a multidisciplinary short bowel syndrome program. J Pediatr Surg. 2008 Jan;43(1):20–4. doi:10.1016/j.jpedsurg.2007.09.014 PubMed PMID: 18206449; PubMed Central PMCID: PMC3253359.
Intestinal Failure | Pediatric Surgery NaT [Internet]. [cited 2026 May 25]. Available from: https://www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829019/all/Intestinal_Failure?refer=true
Uchida K, Koike Y, Matsushita K, et al. Meconium peritonitis: Prenatal diagnosis of a rare entity and postnatal management. Intractable Rare Dis Res. 2015 May;4(2):93–7. doi:10.5582/irdr.2015.01011 PubMed PMID: 25984428; PubMed Central PMCID: PMC4428193.
Krishnan P, Lotfollahzadeh S. Spontaneous Intestinal Perforation of the Newborn. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 [cited 2026 May 25]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK585031/ PubMed PMID: 36251805.
Güney C. Evaluation of Gastrointestinal Perforations in Newborns: A Single Center Experience. Haydarpasa Numune Train Res Hosp Med J. 2021. doi:10.14744/hnhj.2021.60243
Rathi C, Khedkar K, Karotkar S, et al. Intra-Uterine Perforation Presented as a Giant Cystic Abdominal Mass in a Neonate: A Giant Meconium Pseudocyst. Cureus. 15(1):e33625. doi:10.7759/cureus.33625 PubMed PMID: 36788879; PubMed Central PMCID: PMC9918329.
Farah M, Hickey A, Hoare S, et al. Meconium peritonitis and pseudocyst in a preterm infant with trisomy 21. Ir Med J. 2024;117(5).
Eaton S, Ganji N, Thyoka M, et al. STAT trial: stoma or intestinal anastomosis for necrotizing enterocolitis: a multicentre randomized controlled trial. Pediatr Surg Int. 2024;40(1):279. doi:10.1007/s00383-024-05853-3 PubMed PMID: 39470842; PubMed Central PMCID: PMC11522064.
Duran R, Vatansever Ü, Aksu B, et al. Intestinal perforation: Rewiev of our experience in the neonatal period. Turk Arch Pediatr. 2007;42(1):33–6.
Koyuncu UDE. Nekrotizan Enterokolit ve Spontan İntestinal Perforasyon. Klin Tıp Pediatri Derg. 2016 Mar 30;8(2):65–82.
Shin R, Lee SM, Sohn B, et al. Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation. Ann Coloproctology. 2016;32(6):221. doi:10.3393/ac.2016.32.6.221
Gimbel K, Greene AC, Hughes JM, et al. Optimal Timing of Stoma Closure in Premature Infants Affected by Necrotizing Enterocolitis. J Surg Res. 2025 Jan 1;305:265–74. doi:10.1016/j.jss.2024.11.033
