ENTERIC FISTULAS AND NECROTIZING ENTEROCOLITIS

The incidence, presentation, significance, and outcome of infants with internal enteric fistula formation secondary to necrotizing enterocol itis (NEC) were examined. Of 130 infants with NEC treated during a 7-y ear period, an enteric fistula developed in five (4%). The gestational age of these patients (3 boys, 2 girls) ranged from 25 to 40 weeks an d their birth weight ranged from 800 to 3,460 g. Two had Down's syndro me. Plain abdominal radiographs showed widespread intramural gas in al l, and portal vein gas in two. Four patients required early laparotomy , which confirmed extensive intestinal necrosis; a diverting jejunosto my or ileostomy was constructed in three, and the abdomen was closed w ith drainage in one. Fistulas were diagnosed by contrast radiology bet ween 16 and 51 days after the onset of NEC, and were jejunocolic (2), ileocolic (2), and colocolic (1). They were associated with enteric st ricture(s), and inflammatory mass, and clinical signs of intermittent sepsis. One infant with an ileocolic fistula died of sepsis before def initive surgical treatment. Of the four who underwent surgery, two sur vived after limited intestinal resection, but one of the two with shor t bowel syndrome died. Enteric fistula formation is a rare complicatio n of NEC. Typically it occurs with colonic stricture(s) and is associa ted with signs of incomplete bowel obstruction and intermittent sepsis . Resectional surgery is successful, but there appears to be a signifi cant risk of short bowel syndrome. Copyright (C) 1996 by W.B. Saunders Company