Peritoneal drainage and ileostomy as a treatment for the acute necrotising enterocolitis

Between 1982 and 1987, in the "Centre néonatal" of Rocourt (Belgium), 18 cases of necrotising enterocolitis have been operated upon during the acute stage of the disease. The authors explain the advantages and the disadvantages of the classical surgical procedures: laparotomy with exploration of the colon and resection of the necrotic segments followed by immediate reanastomosis or by enterostomy above the resected area. They recommend, however, a minimal laparotomy in the right lower quadrant with ileostomy on the terminal ileum without exploration of the colon or resection of the necrotic segments. The advantages of this technique are: minimal impairment of the general condition which increases the chances of survival; possibility to perform the resection later on when general and local conditions have improved; possibility for the lesions to heal spontaneously with short stenotic segments. Only 1 death among the 18 patients during the acute stage and none during the secondary procedures. In most of the cases, an economical resection could be performed with preservation of as much as possible of the normal bowel.