INCREASING FREQUENCY AND DIAGNOSTIC DIFFI CULTIES OF INTESTINAL STRICTURE AFTER NECROTIZING ENTEROCOLITIS

Background - Stenosis after necrotizing enterocolitis (NEC) has increa sed from 15 to 57% over the last 10 years in our unit. The aim of this study is to point out the difficulty of diagnosis and treatment, and search for factors explaining this increase. Patients and methods. - F rom 1986 to 1991, 42 newborns had NEC, followed by intestinal strictur es in 19 of them (57% of the 33 survivors). Data from these 19 patient s were compared with those of the 14 without intestinal strictures. Th e 33 survivors were also compared with those of an earlier study inclu ding 25 NEC seen from 1979 to 1986. Results. - After medical treatment (n = 12), intestinal stenosis led to occlusion after three weeks, was located to both small and large intestine and was short and tight. Af ter surgical treatment (n = 7), stenosis was shown by opacification be fore digestive anastomosis (n = 5) or revealed by occlusion (n = 2); i t stayed on the colon, was long or multiple, requiring extensive resec tions. No difference could be found between data from patients with or without stenosis. Although newborns were actually more premature, the risk of stenosis was more frequent when newborns of same gestational ages and/or weights were compared. Conclusions. - Intestinal stenosis is a frequent complication after NEC; its diagnosis is often difficult and requires extensive digestive resections. No clinical or therapeut ic factor could be found to explain the actual increase infrequency.