Is contrast study done routinely to R/O strictures even for those who are earlier managed medically?
I do not consider routinely perform contrast enema in medically treated NEC patients, but in this case as, ıt had been operated on, for example, ileostomy. I routinely want to see the status of colon by the distal bowel passage enema before closing ileostomy .
stricture can occur even in medically treated NEC patients, but we do not use systematic contrast enema .of course , we do when the process of feeding resuming fails ( abdominal distension, sub occlusive episods). In these case we now tend to ask for an enteric MRI, but this is not always informative so far, un our expérience. In case of surgical derivated patients, we , as Dr Ozkan, often assess the distal part of the bowell before the stoma closure. Not too early, owe to the possible delay ( 4 to 6 weeks in my experience) of the definitive stricture constitution.
By medically treated NEC , we do contrast study when the Feeding Process failed only if the enteric MRI couldnt provide detailed Information.
By the surgical treated cases ( with Ileostoma ) we do always contrast study before closing the Ileostoma.
As NEC can cause ischemic strictures in watershed as well as in non-watershed areas of the intestinal tract as sequelae to medically and surgically treated NEC, our practice mode for medically treated NEC is when re-instituting feeds and intolerance is exhibited contrast studies are required, UGISBFT. If the contrast flows unobstructed to the colon, patient, slow feeds are started. Do not rush the bowel. In pts who have had an enterostomy performed for perforated NEC, we always image the distal bowel/colon before establishing intestinal continuity.
Used to perform contrast study 6 weeks post medical Rx, this however can miss the late stricture. I have stopped this practice now, and only perform contrast studies on those with signs and symptoms of obstruction.
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