Laparoscopic localization and microlaparotomy for focal isolated perforation in necrotizing enterocolitis: an alternative approach to a challenging problem

Abstract Background Necrotizing enterocolitis has a wide clinical spectrum of manifestation. We report a novel method of managing focal isolated perforation in necrotizing enterocolitis by using diagnostic laparoscopy to localize the site of perforation and by making a microincision over the perfora...

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Published in:	Journal of pediatric surgery Vol. 46; no. 2; pp. 424 - 427
Main Authors:	Nah, Shireen A, Tan, Hock-Lim, Tamba, Riana P, Aziz, Dayang A, Azzam, Nurliza
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-02-2011
Subjects:	Diagnosis, Differential Enterocolitis, Necrotizing - diagnosis Enterocolitis, Necrotizing - pathology Enterocolitis, Necrotizing - surgery Humans Infant, Extremely Low Birth Weight Infant, Low Birth Weight Infant, Newborn Intestinal Perforation - diagnosis Intestinal Perforation - pathology Intestinal Perforation - surgery Isolated intestinal perforation Laparoscopy Laparoscopy - methods Laparotomy - methods Microsurgery - methods NEC Necrotizing enterocolitis Pediatrics Surgery Treatment Outcome Necrotizing enterocolitis Laparoscopy NEC Isolated intestinal perforation
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Summary:	Abstract Background Necrotizing enterocolitis has a wide clinical spectrum of manifestation. We report a novel method of managing focal isolated perforation in necrotizing enterocolitis by using diagnostic laparoscopy to localize the site of perforation and by making a microincision over the perforation to perform exteriorization or limited resection and primary anastomosis. Methods We included low–birth weight infants presenting with sudden clinical deterioration and pneumoperitoneum. Patients with gross abdominal wall signs were excluded on the probability that they had extensive disease. Diagnostic laparoscopy was performed using a 3.5-mm trocar and 1.9-mm telescope. A 1-cm incision was made over the site of perforation, and local surgical debridement was performed. Results There were 3 extremely low–birth weight patients (580, 700, and 780 g) and 1 larger infant (1.6 kg). In all cases, an isolated perforation was detected. None had widespread disease. The 3 smaller infants had exteriorization and enterostomies. The larger patient had resection and primary anastomosis. All patients recovered uneventfully. Conclusion Diagnostic laparoscopy can be safely performed in extremely low–birth weight infants. It allows precise identification of the site of perforation to perform a limited microlaparotomy at this site, significantly reducing the surgical trauma of extensive bowel handling. We report a novel method of managing this vexing problem.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0022-3468 1531-5037
DOI:	10.1016/j.jpedsurg.2010.11.045