The common surgical indication for operative intervention in necrotizing enterocolitis is intestinal perforation. A temporary jejunostomy or ileostomy, which was opened because of the NEC and these transient stomas have the high morbidity (diarrhea, severe damage to the skin of the stoma surroundings, inability to gain weight). For these reasons, it should be closed as soon as possible. And then.
You can close the jejunostomy after 3 weeks you perform ostomy safely.
Dear Aybars
It depends on the amount of resection,and the general condition of patient. age and comorbidities,the presence of sepsis or not. Please explain in details.
Dear Seyed- Hassan
Thank you very much for your kind attention.
I give information about our patients: A girl neonate was born 30 gestational weeks premature in 1540 grams who was monitored in NICU. The 8th day was detected NEC-associated intestinal perforation. She was operated urgently. At operation; necrosis and perforation area were identified on jejunum and the proximal ileum. This site of perforation area was created temporary stoma... In the previous period of perforation and surgery, she was receiving treatment due to sepsis and respiratory distress. She is for 3 weeks old now. Currently post - op 2nd-week orogastric tube feeding was started, but bicarbonate loss due to diarrhea and acidosis is present. There was also damage to the skin around the stoma. Herein we want to close early the jejunostomy. But we live in hardship regarding the time. How soon can we close the jejunostomy?
The earlier a higher jejunostomy is closed the better it is as it is very difficult to manage. Such patients with a high jejunostomy usually get depleted very quickly with a high morbidity and mortality.
The higher the stoma, the earlier it should be closed, up to 2 weeks from surgery, provided that:
- Normal total proteins and serum albumin levels to ensure sound healing of the anastomosis.
- Absence of infection.
The earlier it should be closed, up to 2 weeks from surgery, provided that:- Normal total proteins and serum albumin levels to ensure sound healing of the anastomosis.
You need normal serum albumin and proteins level . If you exclud intraabdominal infection ,stoma should be closed
Dear Aybars
I agree with my colleagues, in this patient it is better to close the jejunostomy. But a leakage is predcitable in a patient in sepsis.
Certainly the stoma can be closed after two weeks, it is not however ideal. We would continue TPN for longer and reduce the NG feeds back to trophic amounts to buy time.
Dear Dr Kimble, thank you very much for your interest. We closed the jejunostomy and ileostomy after one month. Intraabdominal view was good and better than we would expect. We made almost no bowel resection. Two anastomoses were comfortable and healed uneventfully within 7 days. Thanks to all the supports of colleagues and for helping.
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