Routine contrast enemas for diagnosing and managing strictures following nonoperative treatment of necrotizing enterocolitis

High Morbidity of Enterostomy and Its Closure in Premature Infants With Necrotizing Enterocolitis

“…[1][2][3][8][9][10][11] Debate continues in the literature 4,5,8,12 regarding the technique of resection and primary anastomosis for infants with NEC, although primary anastomosis remains inherently attractive. Objections to resection and primary anastomosis are multiple 6,11 and include the fear of increased anastomotic complications, the resection of more bowel than necessary, and the concept of enterostomal decompression until an optimal weight has been maintained before intestinal continuity is restored.…”

“…Half of the strictures found in the medically treated patients with NEC were asymptomatic and not treated. 12 In our series, all distal strictures were resected at the time of anastomosis, and therefore, the prospective use of contrast studiesinfluencedthesurgicalmanagementofthesepatients. Perhaps strictures are less likely to resolve among infants with more severe NEC treated with enterostomy.…”

Preoperative distal loop contrast radiograph before closure of an enterostomy in paediatric surgical patients. How much does it affect the procedure or predict early postoperative complications?

“…Because of the low sensitivity for complications the results of the present study do not favour DLCR in babies with NEC. In patients who have had NEC there may be radiologically diagnosed intestinal strictures, which, however, may not be symptomatic [9].…”

“…To ascertain unhindered intestinal passage after the closure of the enterostomy, and to detect signs of disease-specific complications, and to assess the need of surgery in addition to the mere closure of the enterostomy, a distal loop contrast radiograph (DLCR) is widely used. DLCR has been considered particularly useful for cases in which the underlying disease, such as NEC or inflammatory bowel disease, may cause strictures or fistulae in the bowel distal to the enterostomy [8][9][10][11]. In adult surgery for intestinal diseases or for injuries of the rectum and colon have questioned the value of DLCR.…”

Laparoscopic intestinal stricture resection in premature newborn

“…В одном из исследований было установлено, что системати-ческое использование контрастного исследования увеличивает в 2 раза количество диагностированных стриктур, требующих хирургического вмешатель-ства [3]. Очевидно, что чем раньше проведено рент-генологическое исследование, тем больше шансов, что оно выявит стриктуру [6].…”