A newborn suffering from perforated necrotizing enterocolitis is having very poor general condition. He is currently stabilized on ventilator. Which of the following should be done in the management of this patient -
Conservative treatment
Resection and anastomosis
Stabilization with membrane oxygenator and defer surgery
Peritoneal drainage by putting drains in the flanks
Ans. is 'd' i.e., Peritoneal drainage by putting drains in the flanks o Necrotizing enterocolitis (NEC) is the most common life-threatening emergency of the GIT in the newborn period. Management of necrotizing enterocolitis Medical treatment of NEC include Cessation of feeding Nasogastric decompression Administration of i.v. fluids Systemic antibiotic against both gram +ve as well as gram -ye bacteria (after taking samples for blood culture). Ventilation should be assisted if distention is contributing to hypoxia. Early surgery consultation Surgical interventions in NEC Evidence of perforation is an indication for laparotomy and resection of necrotic bowel. Failure to respond to medical management, a single fixed bowel loop, erythema of the abdominal wall and a palpable mass are additional indications of exploratory laparotomy, resection of necrotic bowel and external ostomy diveion. Peritoneal drainage may be helpful for patients with peritonitis who are too unstable to withstand surgery. It is more successful in patients with isolated intestinal perforation. In many patients, no fuher surgical procedure is required. Peritoneal drainage is performed under local anaesthesia. A penrose drain is placed in the right lower quadrant and permitted to drain peritoneal contents and decompress the abdomen. This procedure is employed predominantly in infants less than 1000g who have severe SIRS and are viewed as too unstable to be transpoed or to undergo laparotomy. In experienced hands, one third of the patients require only drain placement. A primary anastomosis at the time of initial surgery is indicated in patients with limited localized disease who have no distal bowel involvement and in patients who have demonstrated a walled-off perforation who are no longer manifesting the SIRS. From this discussion, we choose the answer to be peritoneal drainage because : Patients is on ventilator (too unstable). Surgery for NEC is resection and creation of ileostomy, which is not given in the options. Primary anastomosis is done only in stable patients with walled-off perforation.