Diagnosis dan Tatalaksana Enterokolitis Nekrotikans

Abstract

<p>Enterokolitis nekrotikans (EKN) ialah peradangan berat saluran pencernaan yang terjadi pada 5-7% neonatus prematur. EKN merupakan penyebab utama morbiditas dan mortalitas di NICU. Patofisiologi multifaktorial dan belum sepenuhnya diketahui. Deteksi dini sulit karena manifestasi klinis sulit dibedakan dan masih tergantung pada radiologi abdomen yang kurang sensitif. Patofisiologi dan pendekatan diagnosis menjadi topik penelitian prioritas di bidang neonatologi saat ini. Strategi pencegahan dan tatalaksana komprehensif diharapkan dapat ditemukan agar memperbaiki luaran penyakit.</p><p>Necrotizing enterocolitis (NEC) is a serious inflammatory disease of intestine which affects 5-7% preterm neonates. NEC is the leading cause of morbidity and mortality in NICU despite rapid advance in preterm neonatal care. Pathophysiology of NEC is multifactorial and not fully understood. Early detection is challenging because of indistinguishable clinical manifestation and still relies on less sensitive abdominal radiography. Nowadays, pathophysiology and diagnostic approach are priority topics for research in neonatology. Comprehensive prevention and treatment strategies expectedly can improve outcome of disease.</p>

Enterokolitis Nekrotik: Patofisiologi, Diagnosis dan Tatalaksana

“…As a result of anaerobic bacterial metabolism, air will be found in the intestinal submucosal layer, which is called intestinal pneumatosis. Then, some of the indications for surgery are also found due to the presence of pneumoperitoneum (Taufik & Lestari, 2021).…”

“…In addition, most of the intestine is fluid-filled, and it is possible to perform a more detailed visualization of the intestinal wall. Other results that can be found in abdominal ultrasound are size and shape, wall thickness, degree of dilatation, pneumatosis, portal vein air, presence of intraabdominal free fluid, and indications of intestinal perforation (D'Angelo et al, 2018;Taufik & Lestari, 2021). Abdominal ultrasound can be performed in cases that show insignificant clinical symptoms or radiologic results and can be performed to evaluate cases of infants with NEC who do not respond to therapy (Gomella et al, 2020).…”

“…What can differentiate the two is the abdominal radiology examination. In viral enterocolitis, early symptoms may include lymphocytes which are rarely found in cases of NEC (Taufik & Lestari, 2021).…”

“…Some laparotomy procedures depend on the neonate's condition and the extent of the affected bowel, such as focal, multifocal, and total. In stable patients with focal and multifocal bowel damage, the main points are resection and primary anastomosis (Taufik & Lestari, 2021). Ostomy, a surgical procedure to create an opening in the abdominal wall, is indicated in extreme conditions of the infant or significant peritonitis (Ginglen & Butki, 2022).…”

“…In patients with >75% bowel damage, the alternatives are jejunostomy and clip and drop technique. Jejunostomy may be chosen if bowel resection causes significant bleeding or loss of the majority of bowel length in an attempt to avoid extensive bowel resection and stromal complications, whereas clip and drop technique is indicated in extensive bowel resection and stoma-induced complications (Taufik & Lestari, 2021). After surgery, the infant should receive intravenous antibiotics and total parenteral nutrition for at least 2 weeks as well as monitoring for correction of electrolyte imbalance in anemia, and ventilatory support should be provided if needed (Ginglen & Butki, 2022).…”