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Intestinal stenosis following successful medical management of necrotizing enterocolitis
Insights
Necrotizing enterocolitis (NEC) survivors may develop intestinal stenosis, particularly in the left colon. Early screening with barium enema is recommended for infants medically managed for NEC to detect potential stenosis.
Area of Science:
- Pediatrics
- Gastroenterology
- Neonatal Surgery
Background:
- Necrotizing enterocolitis (NEC) management has improved, leading to increased survival rates.
- Long-term sequelae of NEC, such as intestinal stenosis, are becoming more evident in survivors.
- Intestinal stenosis is a significant complication following NEC, impacting patient outcomes.
Purpose of the Study:
- To determine the incidence of intestinal stenosis in infants treated medically for NEC.
- To characterize the clinical presentation and location of colonic stenosis post-NEC.
- To evaluate the effectiveness of nonoperative and operative management strategies for intestinal stenosis.
Main Methods:
- Retrospective review of 62 patients treated for NEC over 5.5 years.
- Analysis of medical records for survivors of NEC to identify cases of intestinal stenosis.
- Barium enema examinations for diagnosis and assessment of colonic stenosis.
Main Results:
- Seven of 28 (25%) medically managed NEC survivors developed intestinal stenosis.
- Stenosis predominantly occurred in the left colon, with a mean onset 23 days post-NEC recovery.
- Only three patients presented with intestinal obstruction symptoms; two were asymptomatic.
- Five patients underwent surgical resection, while two were managed nonoperatively.
Conclusions:
- Medical management of NEC is associated with a high incidence of left-sided colonic stenosis.
- Intestinal stenosis can be asymptomatic and may resolve spontaneously.
- Routine barium enema screening is recommended for NEC survivors before hospital discharge.
- Nonoperative management may be suitable for selected asymptomatic patients with colonic stenosis.
Abstract:
In the past decade, increased clinical awareness and better medical and surgical management of necrotizing enterocolitis (NEC) has resulted in improved survival. With an increase in the number of infants surviving the acute stages of NEC the sequelae, including intestinal stenosis, have become more apparent. In the past 5.5 yr, 62 patients with NEC have been treated at our institution. Of the 28 survivors of medical management for NEC seven patients developed intestinal stenosis. An average of 23 days elapsed between the recovery from NEC and the diagnosis of colonic stenosis. Only three patients manifested symptoms of intestinal obstruction. Two patients had blood in their stools and two patients were asymptomatic. Five infants were managed by primary or staged resection of the intestinal stenosis. The remaining two patients were treated nonoperatively. Our data suggests a high incidence of intestinal stenosis (25%) following medical management of NEC. There is a marked preference for the stenosis to occur on the left side of the colon. Colon stenoses can exist without symptoms and radiographically proven areas of stenosis can resolve. We recommend that all infants following medical management of NEC have a barium enema prior to hospital discharge. In selected cases asymptomatic patients with colonic stenosis may not require operative intervention.