The management of perforated necrotizing enterocolitis - abstract

ABSTRACT

Fourteen patients with perforated, necrotizing enterocolitis (NEC) managed at the University Hospital of the West Indies are reviewed. Seven patients had peritoneal drains sited under local anaesthesia as a resuscitative measure in preparation for laparotomy. Six demised, five within 24 hours of siting drains and one soon after laparotomy. The single survivor after peritoneal drainage responded well enough not to require laparotomy. Four patients had immediate exploration, leading to death in one. Two patients had localized perforation, resulting in abscess formation. Both were drained but were complicated by intestinal stricture. Of these two patients, one survived. Perforated NEC was diagnosed at post-mortem in one patient. We conclude that a high index of suspicion is required for the early detection of NEC perforation. Peritoneal drains have limited application in this condition only in low birth weight and in unstable, perforated neonates under 1,500 gm. Intestinal resection and stoma formation is the recommended operative approach but primary anastomosis is justified for fit, well-resuscitated neonates (AU)