The value of contrast studies in the evaluation of bowel strictures after necrotising enterocolitis

Burnand, Katherine; Zaparackaite, Indre; Lahiri, Rajiv; Parsons, Gillian; Farrugia, Marie‐Klaire; Clarke, Simon A.; DeCaluwe, Diane; Haddad, Munther J.; Choudhry, Muhammad

doi:10.1007/s00383-016-3880-7

Cited by 21 publications

(16 citation statements)

References 20 publications

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“…[20,21] Intestinal strictures develop in 9% to 32% of patients who underwent operation. [4,20,22,23] A contrast study (conventional contrast enema, distal loop enema, or both) is recommended to rule out strictures or complete obstruction before reestablishment of intestinal continuity. Koike et al [24] reported that LBW infants might get benefits from enteral refeeding.…”

Section: Discussionmentioning

confidence: 99%

Short-term surgical outcomes of preterm infants with necrotizing enterocolitis

Sheng

Lv²,

Xu³

et al. 2016

Medicine

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The purpose of this study was to analyze the nature of the disease, the surgical procedures, complications, and survival of preterm infants with necrotizing enterocolitis (NEC) at our institution.Medical records of 34 preterm (gestational age <37 weeks) infants with surgical NEC were retrospectively analyzed from January 2010 to December 2014. Patients were divided into 2 groups: low birth weight (LBW, <2500 g, n = 27) and normal birth weight (NBW, ≥2500 g, n = 7).The LBW and NBW groups differed dramatically in gestational age (31.2 ± 2.2 vs. 36.3 ± 0.5 weeks), and respiratory support (55.5% vs. 0%). The median age of NEC onset was 12 and 5 postnatal days respectively. There was an inverse association between gestational age and day of NEC onset (r = −0.470). Pneumoperitoneum, positive paracentesis, and progressive clinical deterioration were the indications for laparotomy. There was no difference in the extent of disease, in the bowel involvement, in the surgical procedures, and in the postoperative complication rates between the 2 groups. The choice of procedure has often depended upon the extent of disease (enterostomy was performed in most localized and multifocal infants, simple drainage was used in 83.3% pan-intestinal patients, P < 0.001). Postoperative complications occurred in 70.5% patients. The most common complications were sepsis, intestinal stricture, and short bowel syndrome. The median hospital stay was significantly longer in the LBW group (65 vs. 19 days, P = 0.004). The overall postoperative 180-day survival rate was 70.6% (70.4% vs. 71.5%, P = 0.890, log rank test). The severity of illness was the main risk factor for mortality (8.3% in localized, 18.7% in multifocal, and 100% in pan-intestinal, P < 0.001).The short-term outcomes for surgical NEC are grave. The high mortality and postoperative complications in this study mandate urgent improvements in early recognition, expeditious operation, and better perioperative care.

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Section: Discussionmentioning

confidence: 99%

Short-term surgical outcomes of preterm infants with necrotizing enterocolitis

Sheng

Lv²,

Xu³

et al. 2016

Medicine

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“…Despite its high sensitivity, the contrast enema may still miss strictures that are present. When a sufficient amount of contrast does not pass through the ileocecal valve, small bowel strictures can remain undiagnosed (10). Contrast studies were performed in all the patients in our study.…”

Section: Discussionmentioning

confidence: 98%

“…These studies may include contrast enemas, distal loopograms, or both. The sensitivity and specificity of the contrast enema are 93% and 88%, respectively, and for the distal loopogram, they are 50% and 96%, respectively (10,11). Despite its high sensitivity, the contrast enema may still miss strictures that are present.…”

Section: Discussionmentioning

confidence: 99%

Post-necrotizing enterocolitis stricture: a complication that the diagnosis can be missed with a high mortality in infants

İnce¹

2019

Erciyes Med J

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Intestinal stricture following necrotizing enterocolitis (NEC) is often misdiagnosed as recurrent functional constipation, enteritis, and malnutrition, and it increases the rates of morbidity and mortality in infants. Although a number of studies have focused on the potential etiologic factors leading to NEC, the information regarding the occurrence and diagnosis of post-NEC strictures is limited. The aim of this study was to evaluate the clinical presentation and diagnostic and surgical methods to treat NEC. Materials and Methods: The medical records of infants who had undergone surgery for post-NEC strictures between January 2005 and September 2018 were evaluated retrospectively in a single institution. Results: This study included 38 infants (20 males, 18 females) with post-NEC stricture. Their histories revealed that they had been treated medically (20 of 38) or surgically (18 of 38) for NEC. Symptoms typical of intestinal obstruction (vomiting, abdominal distension, constipation, growth retardation, etc.) were present in the medically treated patients. The average time of onset of symptoms after the acute episode of NEC was 1.64±0.78 months. Contrast studies revealed strictures in the small intestine in 13 (65%) medically treated patients, while 13 (72.2%) surgically treated patients had strictures in the colon. Additionally, 2 of surgically treated patients presented with ileocolic fistulae. In 11 of 38 (28.9%) patients, the contrast studies were false-negative. Conclusion: Post-NEC strictures may present with vague nutritional problems, causing the diagnosis to often be missed, which leads to high rates of morbidity and mortality in infants. Colon enemas, distal loopograms, and small bowel passage radiograms are useful in making a diagnosis, but a careful examination of the intestines for the presence of any other strictures should be done during the surgery.

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“…Prematurity, central line access and prolonged parenteral nutrition contribute to increased incidence of septic complication [19]. Intestinal strictures develop in 9-32% of patients who underwent the operation [20]. Stricture occurred after both medical and surgical treatment for NEC and in both functional and defunctionalized bowel.…”

Section: Discussionmentioning

confidence: 99%

Short-term Outcome of Low Birth Weight Preterm Infants with Necrotizing Enterocolitis: A Prospective Cohort Study

Pan¹

2018

J Neonat Surg

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Aim: The purpose of this study was to analyze the nature of the disease, the surgical procedures, complications, and survival of preterm infants with necrotizing enterocolitis (NEC) from two tertiary care referral neonatal intensive units in central India.Materials and Methods: A prospective study of a cohort of 110 preterm neonates with gestational age less than 36 weeks and weight less than 1600 g infants diagnosed to have NEC were followed for 90 days. All the neonates were born between January 2015 and December 2017 and treated at two neonatal intensive care units. Infants with sepsis, congenital gastrointestinal anomalies, major cardiac problems, and intraventricular hemorrhage were excluded.Results: Mean gestational age in this cohort was 32.40 ± 3.87 weeks, and the mean age of NEC onset was 13.04 ± 3.54 postnatal days. There were 39 neonates with Stage 1, 45 with Stage 2, and 26 with stage 3 NEC. Pneumoperitoneum, positive paracentesis and progressive clinical deterioration were the indications for laparotomy. The most common complications were sepsis 97/110 (88.18%). Post-operative complications occurred in 22 (84.61%) infants, wound infection in 19 (73.07%), intestinal stricture in 9 (34.61%), wound dehiscence in 7 (26.92%), stoma stenosis in 3 (11.53%), ileostomy prolapse in 2 (7.69%), and burst abdomen in 1 (3.84 %). The overall 90-day survival rate was 87.27% (96/110), and the post-operative survival rate was 46.15% (12/26). The age of gestation, weight, and extent of the disease were the main risk factor for mortality.Conclusion: The short-term outcomes for Stage 3 NEC were associated with high morbidity and mortality. The outlook for infants with Stage 1 and 2 NEC was favorable.

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The value of contrast studies in the evaluation of bowel strictures after necrotising enterocolitis

Abstract: Colon is the commonest site for post-NEC stricture and contrast enema is the study of choice for detecting these strictures prior to stoma closure.

Cited by 21 publications

References 20 publications

Short-term surgical outcomes of preterm infants with necrotizing enterocolitis

Short-term surgical outcomes of preterm infants with necrotizing enterocolitis

Post-necrotizing enterocolitis stricture: a complication that the diagnosis can be missed with a high mortality in infants

Short-term Outcome of Low Birth Weight Preterm Infants with Necrotizing Enterocolitis: A Prospective Cohort Study

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