Clinical features and management of intestinal strictures after neonatal necrotizing enterocolitis: analysis of 79 cases

Objective To summarize the clinical features and management of intestinal stricture following neonatal necrotizing enterocolitis (NEC). Methods We retrospectively analyzed the clinical data of 79 infants with intestinal stricture following NEC treated in our hospital between April, 2014 and June, 2018. Of the 79 infants, 20 were diagnosed to have Bell stage I NEC, 52 were in Bell stage Ⅱ and 7 in Bell stage Ⅲ. All the infants underwent preoperative X-Ray examination, 73 had gastrointestinal contrast study and 69 had rectal mucosal biopsy. Results In these infants, the clinical signs of intestinal stricture occurred at a mean of 46.5 d following NEC. Among the 73 infants receiving gastrointestinal contrast study, 58 were found to have intestinal stenosis and 6 had fetal colon. Rectal mucosal biopsy in 69 infants revealed Hirschsprung disease in 3 cases. Intraoperative exploration showed that intestinal stenosis occurred mostly in the ascending colon, transverse colon and descending colon, and multiple stenosis was detected in 32 cases. Surgical resection of stricture and primary end-to-end anastomosis were performed in 71 cases, and the remaining 8 cases underwent staged surgeries. In the 73 cases with complete follow-up data, 3 had postoperative adhesions, and 2 of them received conservative treatment and the other underwent a second operation. Eight infants were hospitalized for 1 to 3 times for malnutrition and dehydration due to repeated diarrhea, and eventually recovered and were discharged smoothly; all the other infants had uneventful recovery without stricture recurrence. Conclusion Intestinal stenosis following NEC occurs most frequently in the colon, and some cases may have multiple strictures. Gastrointestinal contrast study is the primary option for examination. Surgical resection of the stricture and primary end-to-end anastomosis can achieve good therapeutic effect with favorable prognoses in the patients.