SURGICAL-PROCEDURES IN COLONIC STRICTURES AFTER NECROTIZING ENTEROCOLITIS

Between 1982 and 1992, 22 patients were treated with colonic stricture s in the course of necrotizing enterocolitis (NEC). Fourteen newborns in whom a primary enterostomy and, when necessary, resection of necrot ic bowel was performed developed strictures in the diverted colon. The strictures were detected by colon contrast enema study performed on a verage 3 months after the first intervention. Eight additional childre n suffered from an ileus due to primary strictures after conservativel y treated NEC, which was surgically managed by enterostomy. Closure of the enterostomy and resection of the stenotic part of the colon was p erformed thereafter in all 22 children as a single stage procedure. Th ere was no insufficiency of the anastomosis nor any late stricture at follow-up 2.7 years after NEC in our patients. It is concluded therefo re that reanastomosis of the enterostomy and resection of an intestina l stricture can be performed as a single stage procedure without any r isk after an interval of 3 months between onset of acute NEC and reeva luation. During this interval, a close monitoring and an appropriate m anagement of adequate supplement of electrolytes and bicarbonates is n ecessary. Most of our babies could be nursed at home and showed a good weight gain during this period, despite the enterostomy.