Abstract
Background Necrotizing enterocolitis (NEC) is one of the main causes of acute abdomen in neonates.
Surgical treatment entails important morbidity and mortality and conservative management,
when possible, offers better outcomes. Post-NEC intestinal strictures are one of the
main complications.
Methods Retrospective analysis from June 2011 to November 2022 of post-NEC strictures (PNS)
after conservative management of neonates diagnosed with NEC (modified Bell stage
IIA or higher) at a tertiary neonatal surgery center.
Results Out of 219 NEC, 126 received initial conservative management (57.5%), 24 (19%) of
which eventually underwent surgery for PNS. Average gestational age and weight at
birth of our cohort were 31.3 ± 4.9 weeks and 1,694 ± 1,009 g.
PNS diagnosis was made 38.4 ± 16.5 days after the NEC episode. 6/24 (25%) were asymptomatic
and diagnosed by screening enema, 11 (46%) presented signs of intestinal obstruction
before the enema could be performed and 7 (29%) after a normal previous protocol study.
Median age at PNS surgery was 56 ± 17.9 days. A total of 2/3 strictures were found
in cecum, ascendent, and transverse colon. Primary resection and anastomosis were
performed in all cases. Feeds were restarted on postoperative day 4.3 ± 2.9. Two cases
presented anastomotic complications (1 dehiscence and 1 stenosis), and no deaths were
recorded.
Conclusions PNS is a frequent complication after conservative management. Deffered surgical treatment
after the acute NEC episode is resolved allows for safer surgeries (since patients
have reached hemodynamical stability and overcome septic shock), shorter resections,
and favorable postoperative outcomes.
Keywords
necrotizing enterocolitis - stricture - conservative management - newborn - premature
