P. S. Jadhav2, P. Choi3, G. Gollin1,2 1Rady Children’s Hospital, Pediatric Surgery, San Diego, CA, USA 2University Of California – San Diego, School Of Medicine, San Diego, CA, USA 3Naval Medical Center, San Diego, Surgery, San Diego, CA, USA
Introduction: Peritoneal drainage is an effective and frequently definitive treatment for spontaneous intestinal perforation (SIP) in infants under 1000 g. Most reports of the procedure describe placement of a Penrose or red rubber catheter via one or two lower quadrant abdominal incisions. We sought to evaluate the safety and efficacy of percutaneous pigtail catheter placement in infants with SIP.
Methods: Patients under 32 wk gestational age who underwent peritoneal drain placement for SIP at one of two NICUs between 2011 and 2022 were identified. Incisional drainage (ID) or percutaneous pigtail catheter drainage (PD) was performed based upon the usual practices of the surgeons. Demographics and physiological parameters at the time of drainage were recorded and short and long-term outcomes were evaluated.
Results: Thirty-seven patients were identified. ID (n=18) was performed via a 5 mm right lower quadrant incision into which a ¼-inch Penrose catheter was placed. An additional left lower quadrant incision was used in one case. The peritoneal cavity was irrigated daily via the drain site with an angiocath. PD (n=19) was accomplished using a Seldinger technique by which a 6.5 or 8 F pigtail catheter was passed through the left lower quadrant. The catheter dead space was irrigated daily. Narcotic sedation and paralysis was used for all procedures. There were no differences in mean gestational age (25.1 wk (SD 2.1)), weight at drain placement (760 g (SD 257)), or use of vasopressors (42%) or high frequency ventilation (34%) between the ID and PD groups. Patients who underwent ID had more frequent stool drainage and blood transfusion after drain placement and achieved full feedings later than those managed with PD. Incisional hernias only developed after ID. (Table) The duration of drain placement (15 vs 11 d , P= .33), length of stay (78.2 vs 98.0 d, P=.31) and time to resolution of pneumoperitoneum (4.4 vs 4.6 d, P= .91) were similar after ID and PD. Incisional and percutaneous drains dislodged (27 vs 26%, P=.92) and were followed by laparotomy (28%vs 32%, P=.92) with equal frequency.
Conclusion: Percutaneous pigtail catheter placement provided effective drainage in infants with SIP with no difference in requirement for laparotomy and no risk for incisional hernia. PD rarely yielded stool, perhaps because of less aggressive dissection and irrigation, but this did not affect outcomes. Differences in immediate transfusion requirement and time to full feedings may be due, in part, to practice differences rather than drainage technique. As PD is straightforward to perform and likely less noxious for the patient, it should be considered as the primary approach for infants with SIP.
