Timing of Optimal Surgical Intervention for Neonates with Necrotizing Enterocolitis

2015 ◽  
Vol 81 (5) ◽  
pp. 438-443 ◽  
Author(s):  
Anthony J. Munaco ◽  
Michellea Veenstra ◽  
Evan Brownie ◽  
Logan A. Danielson ◽  
Kartheek B. Nagappala ◽  
...  
Keyword(s):  
Necrotizing Enterocolitis ◽  
Surgical Intervention ◽  
Abdominal Mass ◽  
Retrospective Chart Review ◽  
Pneumatosis Intestinalis ◽  
Optimal Timing ◽  
Bowel Loop ◽  
Palpable Abdominal Mass ◽  
Indicator Score ◽  
Simple Indicator

Up to half of all patients with necrotizing enterocolitis require acute surgical treatment. Determining when to operate on these patients can be challenging. Utilizing a combination of clinical and metabolic indicators, we sought to identify the optimal timing of surgical intervention. A retrospective chart review was conducted on patients with necrotizing enterocolitis from 2001 to 2010. Previously validated clinical (abdominal erythema, palpable abdominal mass, hypotension), radiographic (pneumoperitoneum, portal venous gas, fixed bowel loop, severe pneumatosis intestinalis), and laboratory (acidosis, bacteremia, hyponatremia, bandemia, neutropenia, thrombocytopenia) indicators were assessed for the ability to predict the need for acute surgical intervention as a simple indicator score, based on the sum of the indicators listed above. A total of 197 patients were included. One hundred and twenty-four procedures (28 peritoneal drains, 96 laparotomy) were performed on 122 patients (62%). Median indicator score was 4 (range: 0–8). Logistic regression identified abdominal erythema (odds ratio [OR] = 3.3, P = 0.001), acidosis (OR = 2.6, P = 0.004), and hypotension (OR = 1.9, P = 0.05) as independently associated with surgical intervention. A significant increase in surgical intervention was noted for patients with indicator score of 3 or more. In conclusion, if three or more indicators exist, operative intervention is very likely required. In the absence of pneumoperitoneum, abdominal erythema, acidosis, and hypotension are especially important.

scholarly journals A Modern View on the Diagnosis and Treatment of Necrotizing Enterocolitis in Newborns

2020 ◽  
Vol 13 (4) ◽  
pp. 362-370
Author(s):  
Irina Yu Karpova ◽  
Daria V Molchanova ◽  
T M Ladygina
Keyword(s):  
Necrotizing Enterocolitis ◽  
Pneumatosis Intestinalis ◽  
Diagnosis And Treatment ◽  
Bowel Loop ◽  
Laboratory Diagnostics ◽  
Vacuum Therapy ◽  
Special Role ◽  
Abdominal Organs ◽  
Diagnostic Role ◽  
Quantitative Changes

The aim of the study is to present modern methods of diagnosis and treatment of necrotizing enterocolitis (NEC) in newborns.According to Russian and foreign literature, up to 7.2% of newborns with NEC are admitted to intensive care units. The overall mortality rate in enterocolitis remains at the level of 15%, and in the surgical stages of the disease ranges from 26 to 31%.It is known that the transferred hypoxia and asphyxia lead to vascular disorders. In addition, colonization of the intestine by pathogenic flora takes the leading place in the progression of the process.In order to diagnose NEC, an overview X-ray of the abdominal organs is performed, which reveals such typical changes as: pneumatosis intestinalis, pneumoperitoneum, gastric dilatation, and the presence of a static bowel loop. Ultrasound examination of the abdominal organs confirms enterocolitis in 90% of cases. If necessary, instrumental examination findings are assessed in dynamics. Quantitative changes in the parameters of procalcitonin, calprotectin, cathelicidin, alkaline phosphadase are detected with the help of laboratory diagnostics. It is noted that TGF-1, FXIII factors, thymic index (TI), proteins (FABP2, claudin-2, GFAP) parameters vary at different stages of the disease.Researchers highlight the importance of NEC prevention, a special role is given to breastfeeding. Treatment of necrotizing enterocolitis depends on the stage of the disease and the severity of symptoms, and consists of conservative therapy and surgical correction. The timeliness and necessity of prescribing antibiotics is being actively discussed. Most surgeons emphasize the therapeutic and diagnostic role of laparocentesis; the imposition of preventive intestinal stomas is considered the operation of choice. The medical periodical publications present the experience of using laparoscopy in newborns with the surgical stage of NEC. In addition to the generally accepted methods of treatment, researchers suggest options aimed at improving the clinical outcome of disease correction (vacuum therapy, the introduction of an "oxygen cocktail").

scholarly journals Benign pneumatosis intestinalis: a cause of massive pneumoperitoneum in the adult

CJEM ◽  
2003 ◽  
Vol 5 (06) ◽  
pp. 416-420 ◽  
Author(s):  
David M. Liu ◽  
William C. Torreggiani ◽  
Kevin Rowan ◽  
Savvas Nicolaou
Keyword(s):  
Bowel Wall ◽  
Surgical Intervention ◽  
Pneumatosis Intestinalis ◽  
Bowel Ischemia ◽  
Benign Condition ◽  
Distinguishing Features

ABSTRACT Pneumatosis intestinalis (gas in the bowel wall) is often a benign condition, but it may mimic bowel ischemia or infarction and lead to unnecessary surgical intervention, especially when associated with pneumoperitoneum. We present a case of benign pneumatosis intestinalis with massive pneumoperitoneum and discuss various distinguishing features that may aid in its diagnosis.

Autoamputation of the Appendix Presenting as a Calcified Abdominal Mass Following Necrotizing Enterocolitis

2017 ◽  
Vol 20 (4) ◽  
pp. 335-339 ◽  
Author(s):  
Brent R Weil ◽  
Alyaa Al-Ibraheemi ◽  
Sara O Vargas ◽  
Shawn J Rangel
Keyword(s):  
Necrotizing Enterocolitis ◽  
Bowel Resection ◽  
Abdominal Mass ◽  
Vermiform Appendix ◽  
Male Child ◽  
Transverse Mesocolon ◽  
Abdominal Radiography ◽  
Unusual Event ◽  
Pathologic Evaluation ◽  
History Of

Autoamputation of the appendix has previously been reported in the literature, but it is likely an unusual event. We report a 2-year-old male child who had previously undergone laparotomy and bowel resection for necrotizing enterocolitis. Two years later a calcified intra-abdominal mass was identified on abdominal radiography and ultrasonography. Eventual laparotomy revealed a densely calcified mass within the transverse mesocolon. The mass was uneventfully resected. Pathologic evaluation showed appendiceal tissue, consistent with prior autoamputation of the vermiform appendix. Autoamputation of the appendix has not to our knowledge previously been associated with a calcified mass nor been associated with a history of necrotizing enterocolitis, and these factors distinguish this case as noteworthy.

scholarly journals Pneumatosis Intestinalis: A Case Report and Approach to Management

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Sean Donovan ◽  
Joseph Cernigliaro ◽  
Nancy Dawson
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Bowel Wall ◽  
Surgical Intervention ◽  
Wide Spectrum ◽  
Pneumatosis Intestinalis ◽  
Rapid Evaluation ◽  
Thought Process ◽  
Diagnostic Dilemma ◽  
Clinical Scenarios

Pneumatosis intestinalis (PI), defined as gas within the bowel wall, is an uncommon radiographic sign which can represent a wide spectrum of diseases and a variety of underlying diagnoses. Because its etiology can vary greatly, management of PI ranges from surgical intervention to outpatient observation (see, Greenstein et al. (2007), Morris et al. (2008), and Peter et al. (2003)). Since PI is infrequently encountered, clinicians may be unfamiliar with its diagnosis and management; this unfamiliarity, combined with the potential necessity for urgent intervention, may place the clinician confronted with PI in a precarious medical scenario. We present a case of pneumatosis intestinalis in a patient who posed a particularly challenging diagnostic dilemma for the primary team. Furthermore, we explore the differential diagnosis prior to revealing the intervention offered to our patient; our concise yet inclusive differential and thought process for rapid evaluation may be of benefit to clinicians presented with similar clinical scenarios.

INTUSSUSCEPTION IN CHILDHOOD

PEDIATRICS ◽  
1960 ◽  
Vol 25 (4) ◽  
pp. 592-597
Author(s):  
M. Moreno Robins ◽  
Henry P. Plenk
Keyword(s):  
Abdominal Pain ◽  
Barium Enema ◽  
Abdominal Mass ◽  
Signs And Symptoms ◽  
Safe Procedure ◽  
General Hospitals ◽  
Small Series ◽  
Bloody Stools ◽  
Palpable Abdominal Mass ◽  
Roentgenographic Examination

A city-wide study of intussusception in childhood is reported. The classic signs and symptoms (vomiting, abdominal pain, bloody stools, palpable abdominal mass) are reported in percentages approximating those previously reported by other authors. Intussusception in childhood occurred about once in every 13,000 admissions to general hospitals. Of 26 cases, 3 had surgery without barium enema. In 11 of 23 patients who had roentgenographic examination the intussusception was reduced by enemas (48%). In one patient the lesion recurred after 24 hours. No deaths were encountered in this small series. Provided certain precautions are followed, barium enema is a safe procedure which will save about one-half of the patients a surgical procedure and unnecessary prolonged hospitalization.

Necrotizing Enterocolitis in the First 24 Hours of Life

PEDIATRICS ◽  
1984 ◽  
Vol 73 (4) ◽  
pp. 476-480 ◽  
Author(s):  
Elizabeth H. Thilo ◽  
Raul A. Lazarte ◽  
Jacinto A. Hernandez
Keyword(s):  
Birth Weight ◽  
Necrotizing Enterocolitis ◽  
Gestational Age ◽  
Surgical Intervention ◽  
Term Infants ◽  
Large Size ◽  
Disease Occurrence ◽  
Near Term ◽  
Degree Of Maturity ◽  
Minute Apgar Score

Necrotizing enterocolitis (NEC) is commonly thought of as occuring in the sick premature infant, usually in the first one to two weeks of life. A review of NEC at the Children's Hospital of Denver over a 5-year period, found that 13 of 79 infants (16.1%) had onset of NEC during the first day of life. These infants were larger (mean birth weight 2,624 ± 849 g), more mature (mean gestational age 37.9 ± 2.5 weeks), and less asphyxiated as judged by Apgar scores (mean five-minute score 8.15 ± 1.07) than infants with onset of NEC after the first day of life (mean birth weight 1,519 ± 586 g, mean gestational age 32.0 ± 3.5 weeks, P < .001, and mean five-minute Apgar score 6.81 ± 1.84, P < .05). Despite their large size and degree of maturity, eight of these infants (62%) showed signs of respiratory distress; four (31%) were polycythemic; four (31%) had either a partial or double-volume exchange transfusion performed; and 11 (85%) were fed prior to developing NEC. Presenting signs of disease, occurrence of sepsis (31%), requirement for surgical intervention (62%), and mortality (30%) were similar for the two groups of infants. It is suggested that term and near-term infants who have significant illness after delivery be treated more like their premature counterparts with cautious introduction of feedings after an adequate period of stabilization.

scholarly journals Early and intermediate outcomes for surgical management of infective endocarditis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Lindsay Volk ◽  
Nina Verghis ◽  
Antonio Chiricolo ◽  
Hirohisa Ikegami ◽  
Leonard Y. Lee ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Surgical Management ◽  
Surgical Intervention ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Patient Death ◽  
Intermediate Outcomes ◽  
Uncertain Outcomes

Abstract Objective The treatment of active infective endocarditis (IE) presents a clinical dilemma with uncertain outcomes. This study sets out to determine the early and intermediate outcomes of patients treated surgically for active IE at an academic medical center. Methods A retrospective chart review was conducted to identify patients who underwent surgical intervention for IE at our institution from July 1st, 2011 to June 30th, 2018. In-patient records were examined to determine etiology of disease, surgical intervention type, postoperative complications, length of stay (LOS), 30-day in-hospital mortality, and 1-year survival. Results Twenty-five patients underwent surgical intervention for active IE. The average age of the patients was 47 ± 14 years old and most of the patients were male (N = 15). The majority of the patients had the mitral valve replaced (N = 10), with the remaining patients having tricuspid (N = 8) and aortic (N = 7) valve replacements. The etiology varied and included intravenous drug use (IVDU), and presence of transvenous catheters. The 30-day in-hospital mortality was 4% with 1 patient death and the 1-year survival was 80%. The average LOS was 27 days ±15 and the longest LOS was 65 days. Conclusions Surgical management of IE can be difficult and challenging however mortality can be minimized with acceptable morbidity. The most common complication was CVA. The average LOS is longer than traditional adult cardiac surgery procedures and the recurrence rate of valvular infection is not minimal especially if the underlying etiology is IVDU.

Car Surfing: Case Studies of a Growing Dangerous Phenomenon

2008 ◽  
Vol 74 (3) ◽  
pp. 260-261
Author(s):  
Steven Clark ◽  
Alicia Mangram ◽  
Ernest Dunn
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Surgical Intervention ◽  
Ventilatory Support ◽  
Retrospective Chart Review ◽  
Severe Injuries ◽  
Revised Trauma Score ◽  
Urban Level ◽  
Trauma Score

Car surfing is a dangerous new pastime for American youth. Car surfing is an activity that is defined as standing (or lying) on a vehicle while it is being driven. This activity frequently results in severe injuries that often require significant surgical intervention. Despite its destructive nature, however, there are many Internet sites that encourage this behavior and view it as amusing. As a result, car surfing is becoming increasingly popular. We conducted a retrospective chart review of all patients injured as a result of car surfing over the last 4 years at our Urban Level II trauma center. Data collected included Injury Severity Score (ISS), Revised Trauma Score (RTS), age, gender, injury pattern, surgical intervention, and length of stay. Eight car surfers were identified. The average age was 17. The average Revised Trauma Score was 6.8 with an average Injury Severity Score of 16.9. Five patients were admitted to the intensive care unit. Four of these five patients needed to be intubated for ventilatory support. Five of the eight patients had significant intracranial injuries. Two patients had epidural hematomas that required evacuation. Two other patients had subdural hematomas that were treated nonoperatively, and one patient had a subarachnoid hemorrhage that was also treated nonoperatively. Four of the eight patients required surgical intervention. There were no deaths in this study. Car surfing leads to severe injuries that can result in significant morbidity. American youth have access to Internet sites that project this activity as an acceptable behavior. Five of our eight patients had a significant intra-cranial injury. Trauma surgeons need to be more aware of this injury phenomenon.

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