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  • Original Article
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Evidence vs experience in the surgical management of necrotizing enterocolitis and focal intestinal perforation

Journal of Perinatology volume 28, pages S14–S17 (2008)Cite this article

Abstract

Introduction:

Necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) are neonatal intestinal emergencies that affect premature infants. Although most cases of early NEC can be successfully managed with medical therapy, prompt surgical intervention is often required for advanced or perforated NEC and FIP.

Methods:

The surgical management and treatment of FIP and NEC are discussed on the basis of literature review and our personal experience.

Results:

Surgical options are diverse, and include peritoneal drainage, laparotomy with diverting ostomy alone, laparotomy with intestinal resection and primary anastomosis or stoma creation, with or without second-look procedures.

Conclusions:

The optimal surgical therapy for FIP and NEC begins with prompt diagnosis and adequate fluid resuscitation. It appears that there is no significant difference in patient outcome based on surgical management alone. However, the infant's weight, comorbidities, surgeon preference and timing of intervention should be taken into account before operative intervention.

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References

  1. Stoll BJ . Epidemiology of necrotizing enterocolitis. Clin Perinatol 1994; 21: 205–218.

    Article  CAS  Google Scholar 

  2. Maayan-Metzger A, Itzchak A, Mazkereth R, Kuint J . Necrotizing enterocolitis in full-term infants: case-control study and review of the literature. J Perinatol 2004; 24: 494–499.

    Article  Google Scholar 

  3. Henry MC, Moss RL . Current issues in the management of necrotizing enterocolitis. Semin Perinatol 2004; 28: 221–233.

    Article  Google Scholar 

  4. Hsueh W, Caplan MS, Qu XW, Tan XD, De Plaen IG, Gonzalez-Crussi F . Neonatal necrotizing enterocolitis: clinical considerations and pathogenetic concepts. Pediatr Dev Pathol 2003; 6: 6–23.

    Article  Google Scholar 

  5. Okuyama H, Kubota A, Oue T, Kuroda S, Ikegami R, Kamiyama M . A comparison of the clinical presentation and outcome of focal intestinal perforation and necrotizing enterocolitis in very-low-birth-weight neonates. Pediatr Surg Int 2002; 18: 704–706.

    PubMed  Google Scholar 

  6. Mintz AC, Applebaum H . Focal gastrointestinal perforations not associated with necrotizing enterocolitis in very low birth weight neonates. J Pediatr Surg 1993; 28: 857–860.

    Article  CAS  Google Scholar 

  7. Morecroft JA, Spitz L, Hamilton PA, Holmes SJ . Necrotizing enterocolitis—multisystem organ failure of the newborn? Acta Paediatr 1994; 396 (Suppl): 21–23.

    Article  CAS  Google Scholar 

  8. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187: 1–7.

    Article  CAS  Google Scholar 

  9. Kurscheid T, Holschneider AM . Necrotizing enterocolitis (NEC)—mortality and long-term results. Eur J Pediatr Surg 1993; 3: 139–143.

    Article  CAS  Google Scholar 

  10. Tatekawa Y, Muraji T, Imai Y, Nishijima E, Tsugawa C . The mechanism of focal intestinal perforations in neonates with low birth weight. Pediatr Surg Int 1999; 15: 549–552.

    Article  CAS  Google Scholar 

  11. Stark AR, Carlo WA, Tyson JE, Papile LA, Wright LL, Shankaran S et al. Adverse effects of early dexamethasone in extremely-low-birth-weight infants. National Institute of Child Health and Human Development Neonatal Research Network. N Engl J Med 2001; 344: 95–101.

    Article  CAS  Google Scholar 

  12. Tam AL, Camberos A, Applebaum H . Surgical decision making in necrotizing enterocolitis and focal intestinal perforation: predictive value of radiologic findings. J Pediatr Surg 2002; 37: 1688–1691.

    Article  Google Scholar 

  13. Blakely ML, Lally KP, McDonald S, Brown RL, Barnhart DC, Ricketts RR et al. Postoperative outcomes of extremely low birth-weight infants with necrotizing enterocolitis or isolated intestinal perforation: a prospective cohort study by the NICHD Neonatal Research Network. Ann Surg 2005; 241: 984–989; discussion 989–994.

    Article  Google Scholar 

  14. Ade-Ajayi N, Kiely E, Drake D, Wheeler R, Spitz L . Resection and primary anastomosis in necrotizing enterocolitis. J R Soc Med 1996; 89: 385–388.

    Article  CAS  Google Scholar 

  15. Weber TR, Lewis JE . The role of second-look laparotomy in necrotizing enterocolitis. J Pediatr Surg 1986; 21: 323–325.

    Article  CAS  Google Scholar 

  16. Vaughan WG, Grosfeld JL, West K, Scherer LR, Villamizar E, Rescorla FJ . Avoidance of stomas and delayed anastomosis for bowel necrosis: the ‘clip and drop-back’ technique. J Pediatr Surg 1996; 31: 542–545.

    Article  CAS  Google Scholar 

  17. Luzzatto C, Previtera C, Boscolo R, Katende M, Orzali A, Guglielmi M . Necrotizing enterocolitis: late surgical results after enterostomy without resection. Eur J Pediatr Surg 1996; 6: 92–94.

    Article  CAS  Google Scholar 

  18. Moore TC . Successful use of the ‘patch, drain, and wait’ laparotomy approach to perforated necrotizing enterocolitis: is hypoxia-triggered ‘good angiogenesis’ involved? Pediatr Surg Int 2000; 16: 356–363.

    Article  CAS  Google Scholar 

  19. Parigi GB, Bragheri R, Minniti S, Verga G . Surgical treatment of necrotizing enterocolitis: when? how? Acta Paediatr 1994; 396 (Suppl): 58–61.

    Article  CAS  Google Scholar 

  20. Cooper A, Ross AJ, O'Neill JA, Schnaufer L . Resection with primary anastomosis for necrotizing enterocolitis: a contrasting view. J Pediatr Surg 1988; 23: 64–68.

    Article  CAS  Google Scholar 

  21. Cass DL, Brandt ML, Patel DL, Nuchtern JG, Minifee PK, Wesson DE . Peritoneal drainage as definitive treatment for neonates with isolated intestinal perforation. J Pediatr Surg 2000; 35: 1531–1536.

    Article  CAS  Google Scholar 

  22. Morgan LJ, Shochat SJ, Hartman GE . Peritoneal drainage as primary management of perforated NEC in the very low birth weight infant. J Pediatr Surg 1994; 29: 310–314; discussion 314–315.

    Article  CAS  Google Scholar 

  23. Lessin MS, Luks FI, Wesselhoeft CW, Gilchrist BF, Iannitti D, DeLuca FG . Peritoneal drainage as definitive treatment for intestinal perforation in infants with extremely low birth weight (<750 g). J Pediatr Surg 1998; 33: 370–372.

    Article  CAS  Google Scholar 

  24. Ein SH, Marshall DG, Girvan D . Peritoneal drainage under local anesthesia for perforations from necrotizing enterocolitis. J Pediatr Surg 1977; 12: 963–967.

    Article  CAS  Google Scholar 

  25. Rovin JD, Rodgers BM, Burns RC, McGahren ED . The role of peritoneal drainage for intestinal perforation in infants with and without necrotizing enterocolitis. J Pediatr Surg 1999; 34: 143–147.

    Article  CAS  Google Scholar 

  26. Ahmed T, Ein S, Moore A . The role of peritoneal drains in treatment of perforated necrotizing enterocolitis: recommendations from recent experience. J Pediatr Surg 1998; 33: 1468–1470.

    Article  CAS  Google Scholar 

  27. Demestre X, Ginovart G, Figueras-Aloy J, Porta R, Krauel X, Garcia-Alix A et al. Peritoneal drainage as primary management in necrotizing enterocolitis: a prospective study. J Pediatr Surg 2002; 37: 1534–1539.

    Article  Google Scholar 

  28. Moss RL, Dimmitt RA, Henry MC, Geraghty N, Efron B . A meta-analysis of peritoneal drainage versus laparotomy for perforated necrotizing enterocolitis. J Pediatr Surg 2001; 36: 1210–1213.

    Article  CAS  Google Scholar 

  29. Moss RL, Dimmitt RA, Barnhart DC, Sylvester KG, Brown RL, Powell DM et al. Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation. N Engl J Med 2006; 354: 2225–2234.

    Article  CAS  Google Scholar 

  30. Horwitz JR, Lally KP, Cheu HW, Vazquez WD, Grosfeld JL, Ziegler MM . Complications after surgical intervention for necrotizing enterocolitis: a multicenter review. J Pediatr Surg 1995; 30: 994–998; discussion 998–999.

    Article  CAS  Google Scholar 

  31. Janik JS, Ein SH, Mancer K . Intestinal stricture after necrotizing enterocolitis. J Pediatr Surg 1981; 16: 438–443.

    Article  CAS  Google Scholar 

  32. Blakely ML, Tyson JE, Lally KP, McDonald S, Stoll BJ, Stevenson DK et al. Laparotomy versus peritoneal drainage for necrotizing enterocolitis or isolated intestinal perforation in extremely low birth weight infants: outcomes through 18 months adjusted age. Pediatrics 2006; 117: e680–e687.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA

    C J Hunter, N Chokshi & H R Ford

  2. Department of Surgery, Childrens Hospital Los Angeles, Los Angeles, CA, USA

    C J Hunter, N Chokshi & H R Ford

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  1. C J Hunter
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  2. N Chokshi
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  3. H R Ford
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Correspondence to H R Ford.

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Hunter, C., Chokshi, N. & Ford, H. Evidence vs experience in the surgical management of necrotizing enterocolitis and focal intestinal perforation. J Perinatol 28 (Suppl 1), S14–S17 (2008). https://doi.org/10.1038/jp.2008.44

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