Use of high jejunostomy in extensive NEC

Area of Science:

• Neonatal surgery
• Pediatric gastroenterology
• Surgical innovation

Background:

• Necrotizing enterocolitis (NEC) poses significant challenges in neonates, especially when extensive bowel involvement precludes standard resection.
• A jejunostomy above the affected bowel is a proposed management strategy for decompression and bowel rest in severe NEC cases.

Observation:

• A 1-month-old infant with NEC and diffuse small bowel involvement, including ileal perforation, underwent exploratory surgery.
• The perforation was repaired, and a jejunostomy was created proximal to the affected segment.

Findings:

• The infant experienced a smooth recovery with central intravenous alimentation, demonstrating steady weight gain.
• Post-operative contrast studies confirmed no colonic stenosis, allowing for successful stoma resection and restoration of bowel continuity.
• The infant achieved normal growth and development post-procedure.

Implications:

• Jejunostomy is a viable and promising surgical option for extensive NEC cases where resection is not possible.
• Early consideration of this approach in infants with severe NEC who do not respond to medical management is recommended.
• This technique facilitates bowel rest and decompression, leading to favorable outcomes in critically ill neonates.