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Is pneumoperitoneum an absolute indication for surgery in necrotizing enterocolitis? 
Is pneumoperitoneum an absolute indication for surgery in necrotizing enterocolitis?
  Vijai D. Upadhyaya, A. N. Gangopadhyay, Anand Pandey, Ashish Upadhyaya,
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Varanasi, India

Author Affiliations: Department of Pediatric Surgery, IMS, BHU, Varanasi, India (Upadhyaya VD, Gangopadhyay AN, Pandey A, Upadhyaya A, Moahan TV, Gopal SC, Gupta DK)

Corresponding Author: Vijai D. Upadhyaya, Department of Pediatric Surgery, IMS, BHU, Varanasi, 221005, India (Tel: +91-0542-2309275; Email: upadhyayavj@rediffmail.com)


Background: Necrotizing enterocolitis (NEC) is the most common gastrointestinal medical/surgical emergency in neonates. Non-operative support is needed in 70% of NEC cases, and surgical intervention in the rest 30%. Historically, pneumoperitoneum has been considered as an absolute indication for laparotomy. In the present study we emphasize that pneumoperitoneum is not an absolute indication for exploratory laparotomy in NEC cases. 

Methods: We prospectively studied 58 patients with severe NEC having pneumoperitoneum on abdominal X-ray in the last 5 years. At the time of admission, the patients were given intravenous fluid, total parental nutrition, blood transfusion and broad spectrum antibiotics followed by abdominal tapping (paracentesis). All the patients with pneumoperitoneum were closely monitored for 48 hours if abdominal tapping was repeated. When the disease seemed to worsen clinically, radiologically and laboratorially, the patient was subjected to exploratory laparotomy.

Results: Of the 58 patients, 40 were treated conservatively whereas 18 underwent surgical intervention. The overall mortality in the present study was 12.1%, including 5% of the patients managed conservatively and 27% of the patients undergoing surgery.

Conclusions: Pneumoperitoneum is not an absolute indication for surgery in cases of neonatal NEC. Most of the patients can be treated conservatively.

Key words: necrotizing enterocolitis; neonates; pneumoperitoneum; surgery

                   World J Pediatr 2008;4(1):41-44

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World Journal of Pediatric Surgery

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