Clinical Characteristics And Surgical Treatment Of Intestinal Stenosis After Necrotizing Enterocolitis In Neonates

Objective:Intestinal stenosis is the most frequent secondary complication post-necrotising enterocolitis in neonates(NEC).Intestinal stenosis developing during or after the conservative management of NEC or after surgical ostomy of NEC.The aim of this study was to explore the clinical features and surgical treatment of intestinal stenosis after necrotizing enterocolitis in neonates.Methods:Medical records of One hundred and seven patients diagnosed with intestinal stenosis after necrotizing enterocolitis in neonatal surgery department of our hospital between January 2011 and December 2016 were reviewed.The clinical characteristics,radiological,the time interval between NEC and the symptoms of the intestinal stenosis,the location of the intestinal stenosis,surgical treatment,management of complications,treatment of concomitant malformations and prognosis were analyzed.Results:67 cases suffered intestinal stenosis after conservative treatment.The major symptom of intestinal obstruction was feeding intolerance?gastric retention?vomiting and abdominal distension;Radiology showed flatulence or low ileum obstruction.Colonic stenosis can be found with colonography in some patients.Symptoms arose after a median of 30.5 days(range 13?86)in the conservatively treated NEC patients.The post-NEC strictures in the conservatively treated NEC patients were mainly located in the distal ileum(ileocecal),ascending colon and transverse colon(splenic flexure).40 patients treated with surgical ostomy were found have bowel stenosis during routine exploration of the distal bowel and had no symptoms associated with intestinal stenosis,intestinal strictures were not found in the proximal bowel but in the distal end of stoma,the time interval between NEC and the symptoms of the intestinal stricture is uncertain.Stoma was closed at a median of 13(range 6-25)weeks.The post-NEC strictures in the patients undergoing surgical ostomy were mainly located in the ascending colon and transverse colon(splenic flexure).A total of 185 strictures were identified in 107 infants and 53 patients had multiple strictures.9 strictures were found in the proximal ileum,42 strictures were found in the distal ileum(ileocecal),63 strictures were found in the ascending colon,41 strictures were found in the transverse colon(splenic flexure),19 strictures were found in the descending colon,11 strictures were found in the sigmoid colon.Colon is the dominant site for stricture formation,the incidence of colonic stricture is 72.4%(134/185).All but 2 cases underwent stage operations for there were still active lesions,accompanied by multiple intestinal stenosis,and the condition was relatively serious,with resection of strictures and primary end-to-end anastomosis,and 16 cases underwent this minimally invasive approach.31 patients with patent ductus arteriosus(PDA)and 4 patients underwent PDA ligation during the operation.One patient with PDA died of pulmonary fibrosis after surgery without PDA ligation.21 patients with cholestatic syndrome received fish-oil lipid emulsion treatment and 4 patients underwent intraoperative cholangiography,and cholangiography showed that the hepatocystic ducts were well developed.High ligation of hernia sac was performed in 9 patients with inguinal oblique hernia.Two cases with Michael's diverticulum and one with intestinal duplication were completely resected during the operation.Two patients had postoperative incision dehiscence,The diets of 106 children were restored 3?6 days after surgery and recovered well.Postoperative follow-up showed that 2 patients were readmitted due to adhesive ileus for conservative treatment,and discharge after improvement,the other children had no adhesion intestinal obstruction or anastomotic stenosis.Conclusion:Intestinal stenosis is the most frequent secondary complication post-necrotising enterocolitis in neonates.The feeding intolerance of NEC children after conservative is the most typical symptom of intestinal obstruction;Stenosis mainly located in the colon and distal ileum,some children have multiple intestinal stenosis;An optimal prognosis may achieved with primary end-to-end anastomosis.It should be confirmed that there is no stricture in the distal intestine during the operation for the 2th stage enteroanastomosis.