Laparoscopy as an adjunct to peritoneal drainage in perforated necrotizing enterocolitis

Intestinal perforation in very low birth weight infants with necrotizing enterocolitis has a high morbidity and mortality. We report the use of laparoscopy on day 30 of life in the treatment of a very low birth weight infant (900 g) with perforated necrotizing enterocolitis. The question of laparotomy versus peritoneal drain is ongoing. Laparoscopy may have a major role to play in the answer to this debate. The versatility of laparoscopy enables good visualization of the bowel and organs: a drain can be placed in a port site if there is no fecal contamination and a more conservative approach is warranted, or a conversion to a laparotomy can be undertaken if there are obvious feces or necrotic bowel. We feel that laparoscopy in the initial evaluation of necrotizing enterocolitis is invaluable, and can avoid potentially unnecessary surgery in an already extremely unwell infant.