A 13-year experience with peritoneal drainage under local anesthesia for necrotizing enterocolitis perforation.
Between 1974 and 1986, inclusive, over 400 newborns with clinical, radiological, and/or pathological evidence of necrotizing enterocolitis (NEC) were treated at the Hospital for Sick Children, Toronto, Ontario. Within this group were 37 babies who had a bowel perforation that was treated with peritoneal drainage under local anesthesia. Eighty-eight percent of the 41 weighed less than 1,500 g and 65% weighed less than 1,000 g; during the same time 40 other neonates (9% of the total) with perforated NEC had laparotomies. Twelve neonates (32%) required only drainage with complete recovery of their intestinal tracts. The remaining 25 (68%) fell into one of three groups: (1) nine (24%) had rapid downhill course, sepsis, and death without laparotomy; (2) nine (24%) had rapid downhill course, sepsis, and laparotomy (five deaths); (3) seven (20%) had slow development of bowel obstruction requiring operation (two deaths). The overall survival rate was 56%. These results continue to indicate that this method is effective in temporizing 88% of the small and/or very ill babies with a NEC perforation. However, an added bonus is that 32% of these newborns treated in this fashion had complete resolution of their disease.
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Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Shandling
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B
Wesson
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Filler
R M
RM
D000772:Anesthesia, Local; D004322:Drainage / Q000379:methods*; D004761:Enterocolitis, Pseudomembranous / Q000150:complications / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D007416:Intestinal Perforation / Q000209:etiology / Q000628:therapy*; D011027:Pneumoperitoneum; D012189:Retrospective Studies