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Late intestinal strictures following successful treatment of necrotizing enterocolitis
G Schimpl1, M E Höllwarth, R Fotter
1Department of Pediatric Surgery, University of Graz, Medical School, Austria.
Insights
Necrotizing enterocolitis (NEC) can lead to intestinal strictures in infants, particularly after proximal diverting enterostomies. Early surgical intervention and medical management improved bowel preservation despite stricture development.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Medicine
Background:
- Necrotizing enterocolitis (NEC) is a serious condition in neonates.
- Intestinal strictures are a known complication of NEC, requiring treatment.
- Previous studies have explored the incidence and management of NEC-related strictures.
Purpose of the Study:
- To determine the incidence of late intestinal strictures following NEC treatment.
- To analyze the impact of different initial NEC treatment modalities on stricture formation.
- To describe the pathological findings and outcomes of stricture resection.
Main Methods:
- Retrospective review of 113 neonates treated for NEC between 1975 and 1992.
- Analysis of 16 patients who developed 25 intestinal strictures.
- Comparison of stricture incidence based on initial treatment: conservative, primary resection, or proximal diverting enterostomy.
- Pathological examination of resected strictures.
Main Results:
- 16 infants (14%) developed 25 intestinal strictures after NEC.
- Strictures were more common in the colon (84%) and often multiple (50%).
- Incidence of strictures was 11% after conservative therapy, 11% after primary resection, and 55% after proximal diverting enterostomies.
- Marked submucosal fibrosis was a consistent pathological finding.
Conclusions:
- Proximal diverting enterostomies significantly increase the risk of late intestinal strictures post-NEC.
- Despite stricture development, initial restrictive surgical therapy and aggressive medical management improved bowel preservation.
- Surgical resection with end-to-end anastomosis is the standard treatment for these strictures.
Abstract:
Between 1975 and 1992, in 16 infants (14%) out of 113 neonates with previous necrotizing enterocolitis (NEC) a total of 25 intestinal strictures had to be treated. Four (16%) were found in the ileum and 21 (84%) in the colon, and in 50% multiple strictures were present. In these 16 patients initial treatment for acute NEC included conservative treatment in 5, primary resection and enterostomies in 6 and proximal diverting enterostomies in 5. Therefore, the incidence of late strictures was 11% after conservative therapy, 11% after primary resection and 55% after primary proximal diverting enterostomies. An average of 49 days elapses between the recovery from NEC and the diagnosis of late strictures in conservatively treated patients. After initial surgical treatment, late strictures were detected on contrast studies on an average of 80 days. In pathologic specimens, marked fibrosis in the submucosa was consistently present in all strictures, whereas inflammatory changes in the mucosa, disruption or hypertrophy of the muscle layers or absence of ganglion cells were seen less frequently. All strictures were resected and primary end-to-end anastomosis was performed. But despite the development of late intestinal strictures, bowel preservation was improved after initial restrictive surgical therapy and aggressive medical treatment.