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Related Experiment Videos

Indications for operation in necrotizing enterocolitis revisited

A M Kosloske1

  • 1Department of Surgery, Ohio State University College of Medicine, Columbus.

Journal of Pediatric Surgery
|May 1, 1994
PubMed
Summary

Identifying intestinal gangrene in infants with necrotizing enterocolitis (NEC) is crucial. Pneumoperitoneum, positive paracentesis, and portal venous gas are strong indicators for surgical intervention in NEC cases.

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Area of Science:

  • Neonatal Surgery
  • Pediatric Gastroenterology
  • Diagnostic Imaging in Neonates

Background:

  • Necrotizing enterocolitis (NEC) is a critical surgical condition in neonates.
  • Surgical intervention for NEC is indicated for intestinal gangrene or perforation.
  • Timely surgical decision-making requires accurate prediction of intestinal gangrene.

Purpose of the Study:

  • To evaluate diagnostic criteria for predicting intestinal gangrene in infants with NEC.
  • To determine the sensitivity, specificity, and predictive values of various clinical and radiographic signs.
  • To establish evidence-based indications for surgical operation in NEC.

Main Methods:

  • Retrospective analysis of 147 infants with documented NEC.
  • Evaluation of 94 infants with confirmed intestinal gangrene.
  • Calculation of epidemiological measures (sensitivity, specificity, predictive values) for 12 pre-operative criteria.

Main Results:

  • High specificity and positive predictive value (approaching 100%) were observed for pneumoperitoneum, positive paracentesis, and portal venous gas (prevalence >10%).
  • Fixed intestinal loops, abdominal wall erythema, and palpable abdominal masses showed good specificity and positive predictive value (prevalence <10%).
  • Severe pneumatosis intestinalis demonstrated fair predictive value (91% specificity, 94% PPV, 20% prevalence); clinical deterioration and other factors had poorer predictive values.

Conclusions:

  • Pneumoperitoneum, positive paracentesis, and portal venous gas are strong indicators for NEC surgery.
  • Portal venous gas should be recognized as a definitive indication for operative intervention.
  • Probability analysis can enhance clinical decision-making for NEC surgical management.

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