CAPS PaperCorrelation of complex ascites with intestinal gangrene and perforation in neonates with necrotizing enterocolitis
Section snippets
Methods
The pediatric surgery service at our institution was consulted in the management of 76 infants with NEC between 2005 and 2008. A retrospective review of their charts was performed. The radiographic reports were obtained and correlated with the clinical course and operative findings described at the time of surgery. Infants with an abdominal radiograph demonstrating free air were excluded from the study. A positive US consisted of particulate matter or debris within the ascites that was either
Results
In the group of patients (n = 76) whose charts were reviewed, 6 infants had free air on abdominal radiograph and were eliminated from the study. Because of clinical deterioration, 23 of the remaining 70 patients had bedside US that demonstrated ascites. Free air was not demonstrated in these patients. Eleven patients with clear ascites did not have a surgical intervention because of the inability to confirm intestinal perforation or complex ascites by US. Of those 11 patients, 3 recovered
Discussion
Surgery in the critically ill neonate can be a daunting intervention because of the fragile nature of the patient and multiple comorbidities. Equally important is a timely surgical intervention that optimizes the infant's chance for recovery and even survival. The difficulty in the early recognition of intestinal gangrene/perforation in the NEC population is well recognized. The most commonly accepted criteria for surgery remains the presence of free air on abdominal radiograph [4]. However,
References (7)
- et al.
Surgical therapy for necrotizing enterocolitis: bringing evidence to the bedside
Semin Pediatr Surg
(2005) - et al.
Necrotizing enterocolitis—bench to bedside: novel and emerging strategies
Semin Pediatr Surg
(2008) Indications for operation in necrotizing enterocolitis revisited
J Pediatr Surg
(1994)
Cited by (0)
Presented at the 41st Annual Meeting of the Canadian Association of Paediatric Surgeons, Halifax, Nova Scotia, Canada, October 1-3, 2009.