NECROTISING ENTEROCOLITIS: SURVIVAL AFTER ULTRA-CONSERVATIVE SURGERY

Brines J, Benlloch-S¨¢nchez C, Lopez-Saiz A, Martinez-Costa C

Department of Pediatrics and Pediatric Surgery, Hospital Clinico, Valencia, Spain

 

Objective: We present the successful adaptive and nutritional evolution of a patient with a massive small-bowel resection, using the technique of intestinal preservation in segments longer than 5 cm.

Patient: A term newborn developed necrotising enterocolitis (NEC) requiring urgent laparotomy on which massive small-bowel necrosis was found, being decided closure and second-look in 48 hours. On secondary operation, extensive gangrene was evidenced, and multiple resections were practised, leaving the fragments longer than 5 cm (20 cm of total small bowel, includiong 2 fragments of jejune, 2 of ileon and 2 of colon) with 9 ostomies. Total parenteral nutrition (TPN) was started, followed by minimum enteral nutrition shortly thereafter. One month later reconstruction was carried out with multiples anastomoses, showing 45 cm of small bowel post-anastomoses with preservation of ileocecal valve. TPN was maintained for four months with gradual addition of enteral supplies including substitutive pancreatic enzymes and resincolesteramine. At fourth month all baby nutrition was enteral. Nowadays, the patient is five years old, his length and weight percentiles are completely normal, and so is his quality of life.

Conclusions:  Despite the initial results of small bowel transplantation, massive resections of small bowell still lead to high morbimortality. The prognosis may drastically improve with an ultraconservative surgery, followed by scrupulous nutritional and metabolic management during, at least, the first year of life.    

 

 

 
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