Acute abdomen

Acute abdomen events arise from a number of diseases based on the predominant pathophysiology. They require urgent revision.

Basic division of acute abdomen in newborns:

• congenital gastrointestinal malformations
• non-inflammatory
  → ileus of prematurity (IOP)
  → spontaneous intestinal perforation (SIP)
  → incarceration of inguinal hernia
  → testicular torsion (unilateral orchidectomy)
• inflammatory
  → necrotizing enterocolitis (NEC)
  → peritonitis (usually secondary)
  → appendicitis (extremely rare in newborns)

Ileus of prematurity

Intestinal immaturity leads to ileus and clinical consequences (delayed and suboptimal meconium passage, distended abdomen with conturing intestinal loops). Associated risk factors include perinatal asphyxia and fetal inflammatory response syndrome, causing splanchnic hypoperfusion. The condition can lead to focal perforation and peritonitis – see below. Treatment can be conservative (enema or clyster), in case of perforation (pneumoperitoneum) – surgery.

Spontaneous intestinal perforation

It is a consequence of a combination of risk factors (prematurity, perinatal asphyxia, prenatal hypoperfusion of splanchnic area). Focal perforation usually happens at the terminal ileum and there is obvious X-ray finding. The infant is endangered by the development of peritonitis.

References

① Vongbhavit K, Underwood MA. Intestinal perforation in the premature infant. J Neonatal Perinatal Med. 2017;10(3):281-289. doi:10.3233/NPM-16148