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 Vol. 7 No. 9, September 2006
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NeoReviews Vol.7 No.9 2006 e456
© 2006 American Academy of Pediatrics

Laparotomy Versus Peritoneal Drainage for Perforated Necrotizing Enterocolitis

Marion C. W. Henry, MD*
R. Lawrence Moss, MD*

* Section of Pediatric Surgery, Yale University School of Medicine, New Haven, Conn

The first 300 words of the full text of this article appear below.


   Objectives
 
After completing this article, readers should be able to:

  1. Discuss the indications for surgical intervention for necrotizing enterocolitis (NEC).
  2. Describe the primary peritoneal drainage procedure for treatment of perforated NEC.


   Introduction
 
Necrotizing enterocolitis (NEC), the most common surgical emergency in the neonatal intensive care unit, remains a challenge to the neonatologist and pediatric surgeon. With the survival of smaller, more preterm infants, the incidence of NEC has increased, (1) and mortality from perforated NEC remains high at 20% to 50%. (2)(3) As surgeons have faced the challenges of managing intestinal perforation in preterm infants, several surgical approaches have evolved. The two most widely used operations for perforated NEC are laparotomy with bowel resection and primary peritoneal drainage (PPD). Preference between these two methods remains controversial and tends to be driven by surgeons or institutions at this time. In this review, we examine the development of these therapies in the context of the supportive evidence, or lack of it, for such treatment approaches.

NEC presents with signs and symptoms of intestinal ischemia and sepsis, including feeding intolerance, gastric residuals, abdominal tenderness and distention, and systemic signs such as hemodynamic instability, apnea, and bradycardia. The physical examination findings most predictive of intestinal necrosis, with nearly 100% specificity, are erythema of the abdominal wall and a fixed abdominal mass. (4)

The presence and severity of NEC is defined using a clinical staging system of physical findings, laboratory data, and radiographic evidence developed by Bell. (5) Initial management consists of fluid resuscitation, hemodynamic support, antibiotic coverage, and bowel rest. Close monitoring includes serial abdominal radiographs to assess for signs of perforation. Although one half to two thirds of infants can be managed medically, (6)(7)(8) up to one half progress . . . [Full Text of this Article]






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