Is pneumoperitoneum an absolute indication for surgery in necrotizing enterocolitis?

Abstract

Background: Necrotizing enterocolitis (NEC) is the most common gastrointestinal medical/surgical emergency in neonates. Non-operative support is needed in 70% of NEC cases, and surgical intervention in the rest 30%. Historically, pneumoperitoneum has been considered as an absolute indication for laparotomy. In the present study we emphasize that pneumoperitoneum is not an absolute indication for exploratory laparotomy in NEC cases. Methods:We prospectively studied 58 patients with severe NEC having pneumoperitoneum on abdominal X-ray in the last 5 years. At the time of admission, the patients were given intravenous À uid, total parental nutrition, blood transfusion and broad spectrum antibiotics followed by abdominal tapping (paracentesis). All the patients with pneumoperitoneum were closely monitored for 48 hours if abdominal tapping was repeated. When the disease seemed to worsen clinically, radiologically and laboratorially, the patient was subjected to exploratory laparotomy. Results:Of the 58 patients, 40 were treated conservatively whereas 18 underwent surgical intervention. The overall mortality in the present study was 12.1%, including 5% of the patients managed conservatively and 27% of the patients undergoing surgery. Conclusions: Pneumoperitoneum is not an absolute indication for surgery in cases of neonatal NEC. Most of the patients can be treated conservatively. World J Pediatr 2008;4(1):41-44

Tapping for pneumoperitoneum in neonates and infants

“…Nonoperative support is needed in 70% of patients with NEC and surgical intervention in the remaining 30% [21]. Nonoperative support is needed in 70% of patients with NEC and surgical intervention in the remaining 30% [21].…”

“…Historically, pneumoperitoneum has been considered as an absolute indication for laparotomy [21,22]. Other relative indications for operative intervention are erythema in the abdominal wall, gas in the portal vein, and positive paracentesis [15].…”

“…Upadhyaya et al [21] after a study on 58 patients with NEC associated with pneumoperitoneum, emphasized that pneumoperitoneum is not an absolute indication for exploratory laparotomy in patients with NEC.…”

The Influence of Surgery Opportunity Choice on the Prognosis of Neonatal Necrotizing Enterocolitis

“…We use the frequent operation methods, such as one-stage resection and anastomasis, enterostomy, enterectomy and enterostomy, abdominal cavity flushing and drainage. [1,2,3,4]…”

Conservative Management of Pneumoperitoneum in Necrotising Enterocolitis- Is it Possible?

“…Surgery has been the standard for managing the pneumoperitoneum. Non-surgical management of this entity in form of peritoneal tapping has been reported sporadically [5]. This study was undertaken to see if peritoneal tapping is a viable treatment option in patients of pneumoperitoneum due to NEC.…”