Necrotizing enterocolitis - surgical management

Abstract

Despite Major Improvements In Surgical Care, Neonatal Necrotizing Enterocolitis (Nec) Remains A Potentially Devastating Condition. Treatment Is Multidisciplinary With Surgery As The Mainstay In Advanced Cases. Bowel Perforation And Gangrene Are The Most Common Indications For Surgery. The Conventional Approach Is Resection Of Non-Viable Bowel, Often With The Bowel Ends Exteriorized. In Well Selected Cases, Primary Anastomosis Can Be Undertaken. Primary Peritoneal Drainage Has Been Advocated As A Resuscitative Measure For Nec In Extremely Sick Low Birthweight Infants. Extensive Nec Which Is Either Diffuse Or Involves Multiple Bowel Segments Is Associated With A Poor Prognosis. Innovative Treatment Options For Such Cases Include Second-Look Laparotomy, High Jejunostomy, 'Patch, Drain And Wait' And Delayed Primary Anastomosis Involving Initially 'Clip And Drop-Back'. Strictures And Other Long-Term Sequelae Can Complicated Successful Management Of Nec.