title: Laparoscopic localization and microlaparotomy for focal isolated perforation in necrotizing enterocolitis: an alternative approach to a challenging problem.
abstract: BACKGROUND
  Necrotizing enterocolitis has a wide clinical spectrum of manifestation. We report a novel method of managing focal isolated perforation in necrotizing enterocolitis by using diagnostic laparoscopy to localize the site of perforation and by making a microincision over the perforation to perform exteriorization or limited resection and primary anastomosis.
  
  
  METHODS
  We included low-birth weight infants presenting with sudden clinical deterioration and pneumoperitoneum. Patients with gross abdominal wall signs were excluded on the probability that they had extensive disease. Diagnostic laparoscopy was performed using a 3.5-mm trocar and 1.9-mm telescope. A 1-cm incision was made over the site of perforation, and local surgical debridement was performed.
  
  
  RESULTS
  There were 3 extremely low-birth weight patients (580, 700, and 780 g) and 1 larger infant (1.6 kg). In all cases, an isolated perforation was detected. None had widespread disease. The 3 smaller infants had exteriorization and enterostomies. The larger patient had resection and primary anastomosis. All patients recovered uneventfully.
  
  
  CONCLUSIONS
  Diagnostic laparoscopy can be safely performed in extremely low-birth weight infants. It allows precise identification of the site of perforation to perform a limited microlaparotomy at this site, significantly reducing the surgical trauma of extensive bowel handling. We report a novel method of managing this vexing problem.
authors.affiliation: Department of Paediatric Surgery, National University of Malaysia (UKM), Kuala Lumpur, Malaysia.
authors.forename: Shireen A
authors.initials: SA
authors.lastname: Nah
authors.forename: Hock-Lim
authors.initials: HL
authors.lastname: Tan
authors.forename: Riana P
authors.initials: RP
authors.lastname: Tamba
authors.forename: Dayang A
authors.initials: DA
authors.lastname: Aziz
authors.forename: Nurliza
authors.initials: N
authors.lastname: Azzam
mesh_terms: D003937:Diagnosis, Differential; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007416:Intestinal Perforation / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods*; D008866:Microsurgery / Q000379:methods; D016896:Treatment Outcome