Reconstitution of intestinal continuity after resection for neonatal necrotizing enterocolitis

Thirty-five infants were treated surgically for neonatal necrotizing enterocolitis during the past eight years. Twenty-five of these, managed by resection and exteriorization, later underwent reconstitution of the intestinal tract. Eleven infants (69 per cent) with ileostomy and three (100 per cent) with jejunostomy exhibited stenosis or severe dehydration, electrolyte loss and acidosis requiring closure to achieve positive caloric balance. Fewer serious postoperative complications were observed after reanastomosis by Roux-en-Y enteroenterostomy and single limb ileostomy (Bishop Koop) versus end to end anastomosis. Operative mortality for small intestinal stoma closure was 10 per cent. Complications from colostomy formation occurred in 67 per cent. However, fluid and electrolyte loss was not observed and adequate weight gain was achieved in four of six patients allowing for elective closure by end to end anastomosis. Operative mortality for colostomy closure was nil.