[Necrotizing enterocolitis from the viewpoint of the pediatric surgeon--therapeutic considerations].

Abstract

In order to define diagnostic and therapeutic guidelines from a paediatric surgical point of view, clinical, laboratory chemical and intraoperative findings from 52 children with necrotising enterocolitis (NEC) were evaluated and correlated with fatality. This analysis produced the following results: 1. The fatality rate for patients with "proven" NEC (n = 28) was 3 = 9%. All 3 of these children who died were so-called "high risk" patients. The fatality rate for patients with "advanced" NEC (n = 24) with intestinal perforation was 6 = 25%. Five of these children who died were so-called "high risk" patients. These 2 patient groups are comparable because the concepts of surgical indication and timing were identical, the technical conditions for surgery were the same, a standardised surgical procedure was employed, and the distribution pattern and extent of intestinal damage were consistent, except for the intestinal perforation in the second group. In addition, the proportion of "high risk" patients was approximately the same in both groups. Therefore, the 2 groups differed only in the attribute of intestinal perforation. Accordingly, the results of comparison cannot be considered to be statistically significant, yet they do indicate a prognostic tendency: Children who cannot receive surgery until after the occurrence of intestinal perforation have a poorer prognosis. 2. The highly indicative diagnostic criterion for proof of developing intestinal gangrene is puncture of the abdominal cavity, enabling detection of migratory peritonitis. 3. With regard to fatality, a comparison of various surgical procedures confirms the special importance of an enterostoma over primary anastomosis. Exceptions only serve to prove the rule here as well.