Making decisions for surgical intervention in neonates with necrotizing enterocolitis and the selection of appropriate surgical intervention

Year 2017, , 18 - 23, 15.01.2017

Kıvılcım Karadenız Cerıt Rabia Ergelen Tural Abdullayev Zeynep Alp Unkar Aslı Memısoglu Gürsu Kıyan E. Tolga Daglı

https://doi.org/10.5472/marumj.299382

Abstract

Objective: Necrotizing enterocolitis (NEC) is one of the most

common conditions requiring surgical intervention in the neonatal

period. The decision for surgical intervention in NEC is difficult

and the surgical procedures differ according to the condition of the

patient. This study assesses the decision for surgical intervention in

patients being followed with a preliminary diagnosis of NEC and

the appropriate surgical procedure.

Material and Method: The files of patients undergoing

surgery with a diagnosis of NEC at the Marmara University

Hospital Neonatal Intensive Care Unit between 15.07.2013-

15.07.2015 were studied retrospectively. Patients were evaluated

for the following: gestational age, birth weight, gender, time of

onset of symptoms, abdominal distention, tenderness, presence of

abdominal erythema, hypotension, acidosis, thrombocytopenia,

radiological findings, surgical timing and post-operative follow up.

Results: A total of 10 neonates (7 boys, 3 girls) were treated

surgically with an NEC diagnosis. The average gestational age of

the patients was 27.6 weeks (22-37 weeks), and the median birth

weight was 710 grams (400-3750). Average onset of symptoms

was found to be 8.1 days (2-30) postnatal. Abdominal distention

and tenderness (10), hypotension (4), and abdominal erythema

(3) were observed in patients upon physical examination.

Acidosis (7), thrombocytopenia (6) was observed in patients in

laboratory findings. Free fluid (4), thickening of the intestinal

wall ans (3), pneumatosis intestinalis (1), portal venous gas (1)

was observed in patients during the assessment of the abdominal

ultrasonography (US). 3 patients whose direct x-ray evaluations

were grade III underwent peritoneal drainage. The drain site of

one of these patients closed by itself, and there was no need for

further surgery for the patient. Laparotomy was carried out a day

after clinical stabilization was achieved. Our third patient, the

lowest birth weight in our series, was lost immediately following

the peritoneal drainage process. Peritoneal drainage was planned

in two other grade III patients based on the radiological findings.

However, due to the appearance of necrotic bowel segments from

the incision site, they underwent bowel resection and ileostomy

during a bedside laparotomy. One of these patients improved

clinically, but the other patient was lost in the early stages. Due

to the deterioration seen in the clinical findings of 5 patients who

were radiologically grade II, the decision for laparotomy was made

initially. All of these 5 patients were discharged after an uneventful

postoperative period.

Conclusion: In patients who are grade II radiologically, the

decision for surgical intervention in an operating room can be made

according to clinical deterioration. In infants who are grade III, and

whose clinical condition is poor, bedside surgical intervention in

the neonatal intensive care unit is preferable..

Keywords

Necrotizing enterocolitis, Surgery, Laparotomy, Neonatal intensive care unit, Prematurity

References

• Lim JC, Golden JM, Ford HR. Pathogenesis of neonatal
• necrotizing enterocolitis. Pediatr Surg Int 2015; 31: 509-18.
• doi: 10.1007/s00383-015-3697-9