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World Journal of Surgery

, Volume 9, Issue 2, pp 277–284 | Cite as

Surgery of necrotizing enterocolitis

  • Ann M. Kosloske
Progress Symposium—Progress in Pediatric Surgery

Abstract

Necrotizing enterocolitis (NEC) has become a frequent neonatal surgical emergency. This disease, characterized by crepitant intestinal necrosis, occurs primarily in premature infants. Operation is necessary if intestinal perforation or gangrene occurs. Of the many proposed indications for operation in NEC, those of proven validity are: pneumoperitoneum, a fixed dilated loop on serial x-rays, erythema of the abdominal wall, an abdominal mass, or a positive paracentesis (consisting of brown fluid and/or bacteria on Gram's stain). Paracentesis has aided the early identification of infants with intestinal gangrene prior to perforation. Early recognition of gangrene is important because the mortality rate following operation after perforation (64%) is double that of operation for gangrene (30%). The cardinal principles of operation for acute NEC are excision of all the gangrenous bowel, exteriorization of the marginally viable ends, and preservation of as much intestine as possible. Our preferred method of exteriorization is by the Mikulicz enterostomy, because its subsequent closure appears to be safer than closure of a double enterostomy with separated stomas. The survival of infants operated on for NEC at the University of New Mexico Hospital was 34 of 63 (54%). Six late deaths occurred, for an overall survival of 28 of 63 (44%). Nine survivors (32%) required treatment for late intestinal strictures. Recent follow-up studies on infants surviving NEC show an encouraging prognosis for normal growth and development.

Keywords

Premature Infant Como Abdominal Mass Necrotizing Enterocolitis Intestinal Perforation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

L'entérocolite nécrosante est devenue une urgence chirurgicale néonatale fréquente. L'affection qui se manifeste par une nécrose gazeuse de l'intestin survient essentiellement chez les prématurés. L'opération est indispensable en présence de la gangrène ou de la perforation. Les faits en faveur de ces complications sont les suivants: pneumopéritoine, dilatation intestinale permanente sur des radiographies en série, erythème inflammatoire de la paroi abdominale, masse intra-abdominale, paracentèse positive (liquide brun et/ou présence de germes à la coloration). La paracentèse en particulier permet l'identification précoce de la gangrène qui précède la perforation. Le diagnostic précoce de la gangrène est important le taux de mortalité opératoire de la perforation s'élevant à 64% alors que celui de la gangrène est seulement de 30%. Les principes opératoires sont les suivants: exérèse du segment intestinal gangréné, extériorisation des deux extrémités viables de l'intestin, conservation au maximum de l'intestin sain. La méthode préférée d'extériorisation est l'entérostomie type Mickulicz, sa suture secondaire étant plus sûre que celle de la double entérostomie à orifices séparés. La survie des enfants opérés à l'hôpital de L'Université du Nouveau Mexique a atteint le taux de 54% (34/63). Six décès secondaires sont survenus, le taux de la survie étant de 44% (28/63). Neuf des survivants (32%) ont été réopérés pour sténoses intestinales tardives. Une étude récente des opérés en vie a permis de constater un développement normal et une croissance normale de ces sujets.

Resumen

La enterocolitis necrosante (ECN) ha venido a convertirse en una frecuente emergencia neonatal. La enfermedad, que se caracteriza por necrosis intestinal crepitante, ocurre primordialmente en infantes prematuros en las unidades de cuidado intensivo neonatal. La operación se hace necesaria si se presenta la perforación o la gangrena intestinal. Entre las muchas indicaciones que han sido propuestas para operación en la ECN, las que han probado su validez son las siguientes: neumoperitoneo, asa intestinal fija y dilatada en radiografías seriadas, eritema de la pared abdominal, masa abdominal y una paracentesis positiva (líquido oscuro y/o bacterias en la coloratión de gram). La paracentesis ha ayudado en la identificatión precoz de gangrena intestinal antes de que se represente la perforación. El reconocimiento precoz de la gangrena es importante porque la tasa de mortalidad de la operación para perforación (64%) es el doble de la operación para gangrena (30%). Los principios cardinales de la operación para ECN incluyen la resección de todo el intestino gangrenado, la exteriorización de los cabos intestinales marginalmente viables y la preservación de tanto intestino como sea posible. El método de nuestra preferencia es la exteriorización mediante la enterostomía de Mikulicz en virtud de que su posterior cierre parece ser más seguro que el cierre de una enterostomia de doble luz con estomas separados. La supervivencia de los infantes operados por ECN en el Hopsital de la Universidad de New Mexico fué de 34/63 (54%). Se presentaron seis muertes tardías, para una supervivencia global de 28/63 (44%). Nueve sobrevivientes (32%) requirieron tratamiento para estrecheces intestinales tardías. El seguimiento reciente de los infantes que han sobrevivido la ECN demuestra un pronóstico halagador en cuanto a crecimiento y desarrollo normales.

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Copyright information

© Société Internationale de Chirurgie 1985

Authors and Affiliations

  • Ann M. Kosloske
    • 1
  1. 1.Department of SurgeryUniversity of New Mexico School of MedicineAlbuquerqueUSA

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