Necrotizing enterocolitis with extensive intestinal involvement: A strategy for intestinal length preservation

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in the neonatal period and is associated with high morbidity, mortality and intestinal insufficiency. We describe the experience of surgical management of NEC patients with extensive bowel involvement without bowel resection at initial surgery. Retrospective review of neonates with surgical NEC. Patients with involvement of >50 % of the small bowel and/or >50 % of the colon were included. Only a proximal enterostomy without intestinal resection was performed. Patients were divided according to survival and then compared. The software R 4.2.3 (R Core Team, 2023) was used. A p-value of <0.05 was considered statistically significant. 33 patients were included. Only the presence of heart disease was significantly associated with mortality. Bowel reconstruction was performed in 17 patients. During reconstruction surgery, enterostomy closure was performed in 11 (64.7 %) cases, segmental resection in 5 patients (29.4 %) and total colectomy in 1. There was a significant difference in the length of the affected bowel between the initial and reconstruction surgery ( p = < 0.0001). Mortality associated with the NEC episode was 36.4 % and 54.5 % overall. The 15 survivors who underwent intestinal reconstruction received their entire nutritional support by the enteral route. In neonates with NEC and extensive intestinal involvement, proximal enterostomy without initial resection is an alternative treatment with comparable mortality to other strategies, allowing recovery of most of the affected bowel and intestinal sufficiency.