The management of necrotizing enterocolitis by “patch, drain, and wait”

Abstract

The operative management necrotizing enterocolitis continues to be associated with substantial mortality and many difficulties. A new approach is presented with illustrative cases. Neither resection nor enterostomy is a part of this approach, which emphasizes maximum salvage of compromised intestine. Major features of this method are prolonged hyperalimentation, gastrostomy, minimal bowel handling, transverse approximation (“patching”) of the upper and lower margins of a limited number of major perforations, and extensive and prolonged drainage of the peritoneal cavity by Penrose drains placed from both diaphragms to exit sites in the inferior aspects of both lower quadrants. Enteric fistulas developed in the majority of cases presented (4/5) and were “captured” by one or both of the Penrose drains with disappearing peritonitis and the formation of “de facto” enterostomies at one of the drainage sites (generally the left side). “De facto” enterostomies that did not close spontaneously were closed operatively. This approach may also be of value in the management of midgut volvulus with extensive vascular compromise of the midgut.