Intestinal obstruction as a complication of necrotizing enterocolitis in children

Abstract

Introduction. The problem of treatment children with intestinal obstruction on background a necrotizing enterocolitis (NEC) and after this pathology remains an actual subject for a discussion of many specialists today. Aim of this study is the optimization of preventive measures in patients with NEC in order to reduce a quantity cases of NEC complications such as an intestinal obstruction. Materials. 18 children with intestinal obstruction on background and after NEC have been under our observation. 11 patients were newborns and 7 patients were infants from 3 to 11 months old. All newborns had symptoms of early adhesive intestinal obstructions and 7 children had late complications of NEC such as late adhesive intestinal obstruction (3 patients) and intestinal stenosis (4 patients). Clinic and laboratory examination, X-ray and sonographic diagnostic methods have been performed in these patients. Results. Majority of newborns with NEC and intestinal obstruction were premature (81,82%). Among 7 patients of older age 4 children were born premature too. The main reasons for development of intestinal obstruction were the hypomotorics of fixed intestinal loop and necrotizing area with formation of infiltrates around intestinal perforation and preperforated damages of the intestinal wall. The late complications of NEC were diagnosed in 7 children, which had late adhesive intestinal obstruction and intestinal stenosis. Ishemic damages (dysfunction of vascularization of the peritoneum and intestinal wall), long-term infection in the abdominal cavity and other pathological factors are the most frequently reasons of intestinal obstruction after NEC in children. All patients were operated. 2 newborns (18,28%) have died. The reason of mortality was neonatal sepsis with multiple organ failure. Conclusions. 1. Prematurity, ischemia of intestinal wall and intraabdominal infection are the main risk factors of the intestinal obstruction in NEC. 2. The main types of intestinal obstruction in NEC are adhesive intestinal obstruction and intestinal stenosis. 3. The surgical treatment prognosis in children with intestinal obstruction after NEC is positive.