High morbidity of enterostomy and its closure in premature infants with necrotizing enterocolitis.
OBJECTIVE
To review the morbidity and mortality among 68 premature infants treated with enterostomy for necrotizing enterocolitis.


METHODS
Data were collected retrospectively from hospital medical records to include the period between January 1, 1987, and September 30, 1997.


METHODS
Tertiary care children's hospital.


METHODS
A group of 68 infants aged 2 to 35 days (mean age, 12.5 days), weighing 1500 g or less, with necrotizing enterocolitis necessitating surgical enterostomy for treatment.


METHODS
Creation of any enterostomy during exploratory laparotomy for necrotizing enterocolitis and subsequent closure.


METHODS
Morbidity and mortality associated with infant enterostomy and its closure.


RESULTS
Thirty-nine infants underwent ileostomy with mucous fistula, 16 underwent ileostomy with a Hartmann pouch, 7 had jejunostomy with mucous fistula, 2 had colostomy with mucous fistula, and 4 had colostomy with a Hartmann pouch. Eighteen (26%) of the 68 infants died in the postoperative period of sepsis (n = 10), continuing necrotizing enterocolitis (n = 5), or respiratory distress (n = 3). Of the remaining 50 infants, complications developed in 34 (68%). These complications included strictures requiring further resection at the time of enterostomy closure in 20 infants; stricture of the enterostomy requiring surgical revision in 6; incisional hernia in 3; parastomal hernia in 4; enterostomal prolapse or intussusception in 6 and 1, respectively; wound dehiscence in 4; wound infection in 8; small-bowel obstruction requiring laparotomy in 2; and anastomotic complications in 2. Only 16 enterostomies were closed uneventfully, with 3 of these infants subsequently dying of sudden infant death syndrome between 6 and 8 months after the operation. Of the surviving infants, 3 (6%) continue to require home hyperalimentation.


CONCLUSIONS
Although enterostomy in infants with low birth weight with necrotizing enterocolitis may be lifesaving, it is also a major cause of morbidity. These data suggest the feasibility of a prospective study comparing resection and primary anastomosis with resection and enterostomy.
Department of Surgery, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle 98105, USA.
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A
O'Connor
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Sawin
D004761:Enterocolitis, Pseudomembranous / Q000150:complications / Q000601:surgery*; D004766:Enterostomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000601:surgery*; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome