Necrotizing enterocolitis following operation in the neonatal period

Postoperative Necrotizing Enterocolitis Following Incarcerated Inguinal Hernia Repair: Report of a Case

“…Although no blood was found in his stool examinations, which is uncommon in postoperative NEC, the baby passed diarrheic stools, consistent with the observations of Amory et al 1 Other than the dilated loops of bowel, the more distinct radiologic signs of NEC, such as pneumatosis intestinalis or gas in the portal vein and pneumoperitoneum that have ranged between 63% and 100% in some series, were absent. 1,4,5 The rapid and aggressive progression of the disease is consistent with the report by Shanbhogue et al 6 However, a wide range of progressive signs have been described, demonstrated in this case by the lack of chronic changes seen either in the second or third laparotomy. 6 With a few exceptions, almost all infants reported were operated on in the neonatal period, and the disease had a late onset and followed a more benign course.…”

“…7 The role of bacterial overgrowth has been implicated in jejunoileal bypass patients with a clinical syndrome similar to NEC. 8 Hypoperfusion arising from increments in intraluminal pressure leading to mucosal injury was implicated in NEC by Amoury et al 1 The surgical observation of the involvement of almost all of the small intestine which lay proximal to the incarcerated segment and was therefore dilated, in contrast to the intact colon and the viable bowel wall in close proximity to the mesentery, might indicate the role of hypoperfusion in our patient. Ischemia-reperfusion (I/R) injury has also been considered responsible for NEC.…”

“…3 Following this report, Amoury et al presented the first series of postoperative NEC in nine patients who had undergone noncardiac operations. 1 They stressed the significance of abdominal distension, increased gastric drainage, and abnormal stooling patterns as the signs of NEC in babies during the postoperative period. All of these signs were encountered with the progression of the disease in our patient.…”

“…[1][2][3][4][5][6] Herein, we report a case of postoperative NEC developing after an emergency operation for an incarcerated inguinal hernia in a slightly older infant.…”

Necrotizing enterocolitis: A continuing problem in the neonate

“…In an effort to explain the association of gastroschisis and NEC, we postulated that the intestinal wall in gastroschisis may be predisposed to NEC because of a higher than normal tissue pressure (requiring a higher perfusion pressure for an adequate microcirculation) due to: (1) the thickened "peel" that invests the prolapsed gut; and (2) increased intraluminal pressure due to kinks and partial intestinal obstruction [69]. The investing "peel" has been found to be mainly collagen of varying thickness [72].…”