Necrotizing Entero Colitis - Diversity in management.

Ganesh Prabhu, G (2010) Necrotizing Entero Colitis - Diversity in management. Masters thesis, Madurai Medical College, Madurai.

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Abstract

1 INTRODUCTION : Necrotizing enterocolitis (NEC) is the most common surgical emergency occurring in neonates. Necrotizing enterocolitis represents a significant clinical problem and affects close to 10% of infants who weigh less than 1500 g, with mortality rates of 50% or more depending on severity. Although it is more common in premature infants, it can also be observed in term and near-term babies. Necrotizing enterocolitis is a severe inflammatory disorder of the intestine occurring usually in premature infants. It is a major cause of death and morbidity in neonates. In contrast to the improvements during the past 30 years in the outcomes of many conditions affecting premature infants, the mortality rate of 30 to 50 percent for babies with intestinal perforation due to necrotizing enterocolitis remains essentially unchanged. The standard approach to patients with perforated intestine, necrotic intestine, or both is surgical resection of the involved bowel with the creation of intestinal stomas. In a critically ill premature infant, this entails substantial risks. Primary peritoneal drainage, a minimally invasive operation, has evolved as an alternative. It involves a small abdominal incision with placement of a glove drain into the peritoneal cavity without a formal laparotomy or bowel resection. There is considerable controversy regarding which procedure is preferable. In our institution for the past 25 years we were doing laparotomy for all these cases and found unacceptably high mortality. So we decided to do primary peritoneal drainage for these sick babies and the results were analyzed in this study. AIMS AND OBJECTIVES : To improve the results of NEC with established perforation as evidenced by pneumo peritoneum. The treatment protocol was that of conservative management. Primary peritoneal drainage – Glove Flank drain was done bilaterally in lieu of Surgery as the primary modality and the results were analyzed. Glove drain was chosen in place of tube, sump, rubber or PVC drain considering the nature of the soft, inflamed, brittle, distended bowel which perforates even at the slightest provocation. We felt that a soft rubber drain would effectively drain the peritoneal cavity and keep the drainage route patent, while at the same time it would not harm the bowel. CONCLUSION : The mortality rate of cases of perforated NEC treated with primary peritoneal drainage is 20 % when compared to more than 72% in those who underwent laparotomy. All cases of perforated NEC are now treated exclusively by primary peritoneal drainage in our instituition since the results are far superior and better than the laparotomy results. Since this is a small study with limited follow-up, this has to be followed up and corroborated by others. Time and future will stand testimony to this treatment.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Necrotizing Entero Colitis ; Diversity ; management.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Kambaraman B
Date Deposited: 28 Jul 2017 03:33
Last Modified: 28 Jul 2017 03:50
URI: http://repository-tnmgrmu.ac.in/id/eprint/2300

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