Is there a role for high jejunostomy in the management of severe necrotising enterocolitis?

Abstract

Necrotising enterocolitis (NEC) remains a common and severe condition affecting both preterm and term infants. Treatment when NEC involves a large proportion of the gastrointestinal tract remains controversial. We present one surgeon's experience of high jejunostomy (HJ) as the primary procedure in this group of children. HJ was performed in the presence of severe panintestinal disease. In those who survived, a second-look procedure and reconstruction was performed after 6 to 8 weeks. Over a 16-year period, 10 of 113 patients with NEC had a HJ constructed. Two died within 1 day due to persisting instability; the others survived to undergo a second-look laparotomy. Intestinal continuity was restored in all cases with one to five anastomoses. Three patient's died within 1 year from total parenteral nutrition (TPN) related cholestasis and cirrhosis. Five became long-term TPN-free survivors. The HJ as an initial procedure is a useful surgical option in neonates with severe NEC affecting the majority of the intestine. In this high-risk group, we achieved 50% survival from NEC.