Rach Mena, Gabriela Guillén, Sergio Lopez-Fernandez, Marta Martos Rodríguez, César W Ruiz, Alicia Montaner-Ramon, Manuel López, José A Molino
Background: Necrotizing enterocolitis (NEC) is one of the main causes of acute abdomen in neonates. Surgical treatment entails important morbidity and mortality and conservative management, when possible, offers better outcomes. Post-NEC intestinal strictures are one of the main complications.
Methods: Retrospective analysis from June 2011 to November 2022 of post-NEC strictures (PNS) after conservative management of neonates diagnosed with NEC (modified Bell stage IIA or higher) at a tertiary neonatal surgery center.
Results: Out of 219 NEC, 126 received initial conservative management (57.5%), 24 (19%) of which eventually underwent surgery for PNS. Average gestational age and weight at birth of our cohort were 31.3 ± 4.9 weeks and 1,694 ± 1,009 g.PNS diagnosis was made 38.4 ± 16.5 days after the NEC episode. 6/24 (25%) were asymptomatic and diagnosed by screening enema, 11 (46%) presented signs of intestinal obstruction before the enema could be performed and 7 (29%) after a normal previous protocol study.Median age at PNS surgery was 56 ± 17.9 days. A total of 2/3 strictures were found in cecum, ascendent, and transverse colon. Primary resection and anastomosis were performed in all cases. Feeds were restarted on postoperative day 4.3 ± 2.9. Two cases presented anastomotic complications (1 dehiscence and 1 stenosis), and no deaths were recorded.
Conclusions: PNS is a frequent complication after conservative management. Deffered surgical treatment after the acute NEC episode is resolved allows for safer surgeries (since patients have reached hemodynamical stability and overcome septic shock), shorter resections, and favorable postoperative outcomes.
Type: video · 0 min · posted 2025-01-31 Canonical: https://library.globalcastmd.com/watch/conservative-management-of-necrotizing-enterocolitis-in-newborns-incidence-and-management-of-intestinal-strictures-9738 ## Chapters - [0:00](https://library.globalcastmd.com/watch/conservative-management-of-necrotizing-enterocolitis-in-newborns-incidence-and-management-of-intestinal-strictures-9738?t=0) Incidence of Intestinal Strictures After Conservative NEC Management ## Statements - "The study was a retrospective review of all patients who underwent conservative management of modified Bell stage 2A or greater NEC at a single institution from 2011 to 2022." — Alex Halpern (clinical) [0:13](https://library.globalcastmd.com/watch/conservative-management-of-necrotizing-enterocolitis-in-newborns-incidence-and-management-of-intestinal-strictures-9738?t=13) - "126 patients underwent conservative management of NEC in the study period." — Alex Halpern (epidemiological) [0:27](https://library.globalcastmd.com/watch/conservative-management-of-necrotizing-enterocolitis-in-newborns-incidence-and-management-of-intestinal-strictures-9738?t=27) - "24 of the 126 patients eventually underwent surgery for a post-NEC stricture." — Alex Halpern (clinical) [0:27](https://library.globalcastmd.com/watch/conservative-management-of-necrotizing-enterocolitis-in-newborns-incidence-and-management-of-intestinal-strictures-9738?t=27) - "Primary resection and anastomosis was performed in all cases of post-NEC stricture requiring surgery." — Alex Halpern (clinical) [0:36](https://library.globalcastmd.com/watch/conservative-management-of-necrotizing-enterocolitis-in-newborns-incidence-and-management-of-intestinal-strictures-9738?t=36) - "Post-NEC strictures are a common occurrence after conservative management of NEC." — Alex Halpern (opinion) [0:40](https://library.globalcastmd.com/watch/conservative-management-of-necrotizing-enterocolitis-in-newborns-incidence-and-management-of-intestinal-strictures-9738?t=40) ## Transcript How big of a problem are intestinal strictures after conservative management of necrotizing enterocolitis? I'm Alex Halpern, a research fellow from Children's National, and this is an article that you should know. To try and answer this question, men al performed the retrospective review of all patients who underwent conservative management of modified Bell stage 2A or greater neck at a single institution from 2011 to 2022. They found that 126 patients underwent conservative management of neck, and 24 of those patients eventually underwent surgery for a post neck stricture. Primary resection and anastomosis was performed in all cases. So, it seems like post neck strictures are a common occurrence after conservative management of neck. Does this information change your practice at all? Let us know what you think in the comments below. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai