Necrotizing enterocolitis: early conventional and fluorescein laparoscopic assessment

Area of Science:

• Pediatric Surgery
• Neonatal Care
• Diagnostic Imaging

Background:

• Necrotizing enterocolitis (NEC) diagnosis can be challenging, with standard imaging often failing to reveal the full extent of bowel damage.
• Early identification of full-thickness necrosis or perforation is crucial for timely surgical intervention and improved patient outcomes.

Purpose of the Study:

• To establish early signs of full-thickness necrosis or perforation in patients with suspected NEC.
• To evaluate the utility of standard and fluorescein laparoscopy in diagnosing NEC complications prior to clinical deterioration.

Main Methods:

• Thirteen neonates with suspected NEC underwent diagnostic laparoscopy.
• Standard laparoscopy assessed bowel ischemia, fibrin, adhesions, and free intestinal contents.
• Fluorescein-aided laparoscopy was utilized in 8 patients to enhance visualization of necrotic bowel segments.

Main Results:

• Standard laparoscopy identified perforation in 5 patients and gangrenous bowel in 2.
• Fluorescein laparoscopy identified 3 additional cases of gangrenous bowel.
• Ten patients with positive findings underwent laparotomy; 11 of 13 patients survived.

Conclusions:

• Laparoscopy significantly improves the assessment of patients diagnosed with NEC.
• Early identification of perforation and necrosis is facilitated by laparoscopic techniques.
• Fluorescein laparoscopy offers added benefit in detecting necrotic bowel segments when ischemia is suspected.