ISSN:
1437-9813
Schlagwort(e):
Necrotizing enterocolitis
;
Complications
;
Operative treatment
;
Mortality
Quelle:
Springer Online Journal Archives 1860-2000
Thema:
Medizin
Notizen:
Abstract From 1975 to 1991, 132 patients with necrotizing enterocolitis (NEC) were treated at the Department of Pediatric Surgery in Graz. Two of 49 conservatively treated patients died (4%), 1 of these was not operated upon due to complex additional malformations, and the other, a baby with 860 g birth weight (BW), could not be resuscitated sucessfully. Eighty-three patients were treated operatively, 78% with intestinal resection and exteriorization of the bowel. The mean gestational age (GA) was 36 weeks, the mean BW 2,400 g. Nearly all the patients had a medical history of one or more of the well-known predisposing risk factors; 65% had an intestinal perforation at laparotomy, 25% a transmural intestinal necrosis, and 10% pneumatosis or hemorrhagic inflammation of the intestine. Overall mortality in operated patients was 21.7% (n = 18), including 4 deaths in patients with total intestinal necrosis. There were 12 operative deaths, mainly due to progressive septicemia or total intestinal necrosis, and 6 late deaths due to infection, congenital heart disease, or cerebral disease. The mortality declined from 34% before 1985 to 7.7% after 1985 and 6.3% in the last 5 years of this study. Thirty operative complications consisted chiefly of late stenoses, ileus, or late anastomotic complications. Among these patients, only 1 with septicemia after ileostomy closure died. In contrast, all major nonoperative complications caused death, primarily due to infectious problems with septicemia. Mature granulocytes at admission were significantly higher among operated survivors (42.9% vs 23.0%) and represented a valuable predictor of patient survival. In conclusion, despite some differences in this population group with respect to the literature (higher GA and BW), the results show a definite increase in survival, reaching more than 90% of operated patients with NEC.
Materialart:
Digitale Medien
URL:
http://dx.doi.org/10.1007/BF00178820
Permalink
