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.