title: Is pneumoperitoneum an absolute indication for surgery in necrotizing enterocolitis?
abstract: BACKGROUND
  Necrotizing enterocolitis (NEC) is the most common gastrointestinal medical/surgical emergency in neonates. Non-operative support is needed in 70% of NEC cases, and surgical intervention in the rest 30%. Historically, pneumoperitoneum has been considered as an absolute indication for laparotomy. In the present study we emphasize that pneumoperitoneum is not an absolute indication for exploratory laparotomy in NEC cases.
  
  
  METHODS
  We prospectively studied 58 patients with severe NEC having pneumoperitoneum on abdominal X-ray in the last 5 years. At the time of admission, the patients were given intravenous fluid, total parental nutrition, blood transfusion and broad spectrum antibiotics followed by abdominal tapping (paracentesis). All the patients with pneumoperitoneum were closely monitored for 48 hours if abdominal tapping was repeated. When the disease seemed to worsen clinically, radiologically and laboratorially, the patient was subjected to exploratory laparotomy.
  
  
  RESULTS
  Of the 58 patients, 40 were treated conservatively whereas 18 underwent surgical intervention. The overall mortality in the present study was 12.1%, including 5% of the patients managed conservatively and 27% of the patients undergoing surgery.
  
  
  CONCLUSIONS
  Pneumoperitoneum is not an absolute indication for surgery in cases of neonatal NEC. Most of the patients can be treated conservatively.
authors.affiliation: Department of Pediatric Surgery, IMS, BHU, Varanasi, India. upadhyayavj@rediffmail.com
authors.forename: Vijai D
authors.initials: VD
authors.lastname: Upadhyaya
authors.forename: A N
authors.initials: AN
authors.lastname: Gangopadhyay
authors.forename: Anand
authors.initials: A
authors.lastname: Pandey
authors.forename: Ashish
authors.initials: A
authors.lastname: Upadhyaya
authors.forename: T Vittal
authors.initials: TV
authors.lastname: Mohan
authors.forename: S C
authors.initials: SC
authors.lastname: Gopal
authors.forename: D K
authors.initials: DK
authors.lastname: Gupta
mesh_terms: D013505:Digestive System Surgical Procedures; D020345:Enterocolitis, Necrotizing / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases; D007234:Infant, Premature; D008297:Male; D019152:Paracentesis; D011027:Pneumoperitoneum / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D016896:Treatment Outcome