Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jul 3;5(3):28.
doi: 10.21699/jns.v5i3.379. eCollection 2016 Jul-Sep.

Management of Intestinal Strictures Post Conservative Treatment of Necrotizing Enterocolitis: The Long Term Outcome

Christoph Heinrich Houben  1 , Kin Wai Edwin Chan  1 , Jennifer Wai Cheung Mou  1 , Yuk Him Tam  1 , Kim Hung Lee  1
Affiliations

Management of Intestinal Strictures Post Conservative Treatment of Necrotizing Enterocolitis: The Long Term Outcome

Christoph Heinrich Houben et al. J Neonatal Surg. .

Abstract

Objectives: Evaluating the long-term outcome of the surgical management for intestinal strictures developing after necrotizing enterocolitis (NEC).

Patients and methods: This is a retrospective study of all patients with an intestinal stricture after completion of conservative management for NEC. They were treated during the eight years period from 1st January 2008 to 31st December 2015.

Results: During the study period 67 infants had an operation for NEC, of which 55 had emergency surgery. The remaining twelve infants (6 males) had a stricture and were included in the study group. Their median gestational age was 35 (range 27-40) weeks and the median weight was 2180 (range 770 - 3290) g. The onset of NEC was seen at a median of 2 (range 1- 47) days. The median peak C-reactive protein (CRP) level was 73.1 (range 25.2 - 232) mg/dl. Isolated strictures were seen in 9 (75%) patients. Two-third of all strictures (n=15) were located in the colon. Surgery was done at a median of 5 (range 3 - 13) weeks after diagnosing NEC. Primary anastomosis was the procedure of choice; only one needed a temporary colostomy. This cohort had no mortality during a median follow up of 6.25 (range 0.5 - 7.6) years, whilst the overall death rate for NEC was 15 (22 %). Two fifth of the group developed a neurological / sensory impairment.

Conclusion: One fifth of the surgical workload for NEC is related to post-NEC strictures. Most strictures are located in the colonic region. In the long-term no mortality and no surgical co-morbidities were observed.

Keywords: Intestinal stricture; Necrotizing enterocolitis; Neurodevelopmental delay; Primary anastomosis.

PubMed Disclaimer

Figures

None
Figure 1: Panel A contrast enema with sigmoid colon stricture (white arrow) 4 weeks after onset of NEC; Panel B follow-through with distal ileum stricture (black arrow) 4 weeks after onset of NEC.
None
Figure 2: Kaplan-Meier survival curve showing the graph for patients undergoing emergency surgery for NEC (up-arrow) contrasted with those patients who had surgery for post-NEC stricture(s) (down-arrow).
None
Figure 3: Percentile weight distribution of infants with NEC stricture (Note: no infants had IUGR)
None
Figure 4: Graphic illustration of the position of the strictures (n=15) in 12 infants, of which 3 had two strictures each with their respective position marked by bars (a-c).
None
Table 1: Frequency and outcome of post-NEC strictures at different institutions
See this image and copyright information in PMC

References

    1. Kim SS, Albanese CT. Necrotizing enterocolitis. In: Grosfeld JL, O'Neill JA, Fonkalsrud EW, Coran AG (eds). Pediatric Surgery. 6th edn. Philadelphia: Mosby/Elsevier, 2006, pp 1427-52.
    1. Henry MCW, Moss RL. Necrotizing enterocolitis. In: Stringer MD, Oldham KT, Mouriquand PDE (eds). Pediatric Surgery and Urology Long-term Outcomes. 2nd edn. Cambridge: Cambridge University Press, 2006, pp 329-50.
    1. Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med. 2011; 364: 255-64. - PMC - PubMed
    1. Rabinowitz JG, Wolf BS, Feller MR, Krasna I. Colonic changes following necrotizing enterocolitis in the newborn. Am J Roentgenol Radium Ther Nucl Med. 1968; 103: 359-64. - PubMed
    1. Krasna IH, Becker JM, Schneider KM, Beck AR. Colonic stenosis following necrotizing enterocolitis of the newborn. J Ped Surg. 1970; 5: 200-6. - PubMed

LinkOut - more resources