Conservative Management of Pneumoperitoneum in Necrotising Enterocolitis- Is it Possible?

Abstract

Introduction: Necrotizing enterocolitis (NEC) is a common in neonatal intensive care unit (NICU) patients; especially in premature and low birth weight ones. Surgery is indicated when there is pneumoperitoneum. Other therapies include conservative observation or primary peritoneal drain (PPD). This study was conceived to evaluate peritoneal tapping, rather than primary peritoneal drain (PPD) as a treatment of NEC.Material and Methods- This prospective observational study conducted from December 2012 to December 2014 and including all patients of NEC having pneumoperitoneum on X-ray.Results- There were 12 patients of NEC. Seven patients responded to single peritoneal tapping. Three patients needed one more tapping. Laparotomy was required in remaining two patients. One patient, who underwent laparotomy, expired due to severe sepsis. The mean duration of follow up was 4.83 months (range 2 to 8).Conclusion- Peritoneal tapping in NEC who develops pneumoperitoneum appears to be a viable option. Further studies in this regard may substantiate this mode of therapy.

Dilemmas with surgical intervention in neonates with Necrotizing Enterocolitis without pneumoperitoneum

“…In the absence of pneumoperitoneum, we considered surgery in 31% ( 16 Surgical intervention was the mainstay of management for NEC in our study, while according to one recent study, an exploratory laparotomy was performed in only 17% of cases with stage IIIB NEC. [22] The remaining 83% of patients were managed with peritoneal tapping. [22] Some of these patients (abovementioned study) could have spontaneous pneumoperitoneum i.e.…”

“…[22] The remaining 83% of patients were managed with peritoneal tapping. [22] Some of these patients (abovementioned study) could have spontaneous pneumoperitoneum i.e. an intraperitoneal gas without gastrointestinal tract perforation, for which no clear etiology was identified.…”