Diagnosis and treatment of postoperative intestinal perforation in infants and young children with congenital heart disease: A report of three cases

The aim of the present study was to analyze risk factors of intestinal perforation following surgery for the treatment of congenital heart disease in infants and young children, and to summarize experiences of diagnosis and treatment. A total of 3,270 children, who underwent congenital heart disease surgery under extracorporeal circulation from January 2010 to July 2015, were retrospectively analyzed. Among these children, three (0.09%) developed postoperative intestinal perforation. Primary diseases were Tetralogy of Fallot (two cases) and ventricular septal defect combined with atrial septal defect (one case). The age range of the children was 6-11 months and the weight range was 7.3-8.6 kg. Furthermore, these children underwent radical surgery under general anesthesia and extracorporeal circulation in low temperatures. Abdominal symptoms appeared 4-10 days after surgery, and included poor appetite, abdominal distension, intermittent vomiting, high fever, refractory irritability, crying and shortness of breath. One case was confirmed by routine abdominal puncture and the remaining two were confirmed by the detection of free gas under the diaphragm, as revealed by abdominal X-ray. Following the diagnosis of intestinal perforation, emergency intestinal fistula surgery was performed. At 3-5 days post-surgery, the patients underwent treatment by fasting and intravenously administered parenteral nutrition. Diet was increased following recovery of bowel function. All patients recovered following active treatment and 3-4 months following hospital discharge, the fistula was successfully closed. In conclusion, a concerted effort should be made to identify intestinal perforation in infants and young children with postoperative congenital heart disease during emergency surgery. Farly diagnosis and treatment may significantly improve prognosis and reduce mortality.