Necrotizing enterocolitis: late surgical results after enterostomy without resection.
Between January 1985 and December 1992, 36 neonates were treated for necrotizing enterocolitis (NEC). 13/36 were treated conservatively and 2 (18%) died. 23/36 required surgical treatment at birth and 6/23 (26%) died; 14, out of 17 surviving initial surgery, underwent reintervention to restore intestinal continuity, 3 to 26 months later. In these 14 infants the acute necrotizing process involved the whole colon and ileum in 3 cases, the whole colon in 5, part of the colon in 3, part of the colon and ileum in 2 and was confined to the ileum in 1. 11 cases were perforated. During their first laparotomy all 14 cases had a decompressive enterostomy without resection. 21 reoperations were later needed in these 14 patients: simple enterostomy closure was performed in only 1 case, while resection of delayed strictures was required in 13. 12 cases underwent partial colectomy, 3 of these had multiple segmental resections for skip lesions and only 1 child had a total colectomy. The only postoperative complication was one anastomotic leak. Two children had short-gut syndrome but later outgrew their need for parenteral nutrition. Our experience does not support the need of resecting the gangrenous bowel in the acute phase. A simple diverting enterostomy seems to be effective treatment. Delaying the intestinal resection up to the time of recanalisation allows spontaneous healing and results in the sparing of a significant length of bowel.
Luzzatto
C
C
Division of Pediatric Surgery, University of Padova, Italy.
Previtera
C
C
Boscolo
R
R
Katende
M
M
Orzali
A
A
Guglielmi
M
M
D003082:Colectomy; D004322:Drainage / Q000379:methods; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000601:surgery*; D004766:Enterostomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007813:Laparotomy; D008297:Male; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome