Late intestinal strictures following successful treatment of necrotizing enterocolitis

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 1 I YO after conservative therapy, 1 1 Yo 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. 0 Late intestinal strictures, necrotizing enterocolitis G Schimpl,

Morphologic Alterations of the Enteric Nervous System and Deficiency of Non-Adrenergic Non-Cholinergic Inhibitory Innervation in Neonatal Necrotizing Enterocolitis

“…However, fibrotic scaring may not represent the only mechanism of stricture formations: Reports of pseudo-strictures (1) and spontaneous resolution of strictures following NNEC (25) had been explained by the formation of strictures which, after sustaining only moderate ischemic damage, heal without much fibrosis but the bowel subsequently continues to function abnormally. When assessment of nervous tissue had been included from histological examination, strictures showed an absence of ganglion cells in approximately 12 % (21). A deficiency in NANCinhibitory innervation within the intestinal segments affected by NNEC may promote the formation of functional obstructions after acute onset of NNEC in addition to inflammatory and fibrotic reactions.…”

The ProPrems trial: investigating the effects of probiotics on late onset sepsis in very preterm infants

“…Of those seriously affected, about half will require surgery to repair or excise diseased gastrointestinal tract and 25% will die. Long-term morbidity in survivors includes intestinal strictures, poor nutritional status and neurodevelopmental impairment [31-33]. No specific treatment exists for NEC; generally enteral feeds are ceased, with the administration of intravenous nutrition and broad spectrum antibiotics.…”

Early Persistent Blood Eosinophilia in Necrotizing Enterocolitis Is a Predictor of Late Complications

“…While many survivors of acute NEC suffer few to no sequelae, a meaningful number of infants develop life-threatening complications after successful medical management. Schimpl et al emphasized that intestinal strictures occur in 15-35% of infants recovering from NEC, and stricture formation increases the risk of bowel perforation, septicemia, and death [14]. Hepatic fibrosis and/or stricture occurred 8 times more often in Group 1 versus Group 2 (table 3).…”