Laparoscopic localization and microlaparotomy for focal isolated perforation in necrotizing enterocolitis: An alternative approach to a challenging problem

Shireen A. Nah, Hock Lim Tan, Riana P. Tamba, Dayang Anita Abdul Aziz, Nurliza Azzam

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Necrotizing enterocolitis has a wide clinical spectrum of manifestation. We report a novel method of managing focal isolated perforation in necrotizing enterocolitis by using diagnostic laparoscopy to localize the site of perforation and by making a microincision over the perforation to perform exteriorization or limited resection and primary anastomosis. Methods: We included low-birth weight infants presenting with sudden clinical deterioration and pneumoperitoneum. Patients with gross abdominal wall signs were excluded on the probability that they had extensive disease. Diagnostic laparoscopy was performed using a 3.5-mm trocar and 1.9-mm telescope. A 1-cm incision was made over the site of perforation, and local surgical debridement was performed. Results: There were 3 extremely low-birth weight patients (580, 700, and 780 g) and 1 larger infant (1.6 kg). In all cases, an isolated perforation was detected. None had widespread disease. The 3 smaller infants had exteriorization and enterostomies. The larger patient had resection and primary anastomosis. All patients recovered uneventfully. Conclusion: Diagnostic laparoscopy can be safely performed in extremely low-birth weight infants. It allows precise identification of the site of perforation to perform a limited microlaparotomy at this site, significantly reducing the surgical trauma of extensive bowel handling. We report a novel method of managing this vexing problem.

Original languageEnglish
Pages (from-to)424-427
Number of pages4
JournalJournal of Pediatric Surgery
Volume46
Issue number2
DOIs
Publication statusPublished - Feb 2011

Fingerprint

Necrotizing Enterocolitis
Laparoscopy
Low Birth Weight Infant
Enterostomy
Extremely Low Birth Weight Infant
Telescopes
Pneumoperitoneum
Abdominal Wall
Debridement
Surgical Instruments
Wounds and Injuries

Keywords

  • Isolated intestinal perforation
  • Laparoscopy
  • NEC
  • Necrotizing enterocolitis

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Laparoscopic localization and microlaparotomy for focal isolated perforation in necrotizing enterocolitis : An alternative approach to a challenging problem. / Nah, Shireen A.; Tan, Hock Lim; Tamba, Riana P.; Abdul Aziz, Dayang Anita; Azzam, Nurliza.

In: Journal of Pediatric Surgery, Vol. 46, No. 2, 02.2011, p. 424-427.

Research output: Contribution to journalArticle

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