This study was conducted to evaluate applicability of preoperative investigations to
aid surgical decision-making in patients with necrotizing enterocolitis (NEC) and comprised
53 neonates with 25-32 weeks gestational age. All patients underwent clinical examination,
laboratory and radiological investigations that included abdominal plain X-ray for
assessment of presence and degree of pneumatosis intestinalis (Pn Int), portal venous air
(P VA) and pneumoperitoneum (PP). Bedside diagnostic mini-laparoscopy was performed for
all patients. Then, exploratory laparotomy was carried out and surgical decision was taken
according to the pathological lesions present Radiological examination defined PP in 10,
PVA in 7 patients while Pn. Int was detected in 45 patients, 19 grade I, 20 grade II and 6
grade III. Laparoscopy identified pan-necrosis in 8 cases, long-segment necrosis in 6 cases,
10 cases with perforation and 29 with localized peritonitis with somewhat healthy intestine.
At laparotomy, pan-necrosis was confronted with in 8 cases that underwent non-therapeutic
laparotomy (NTL) and drainage, 8 patients had long jejunal loop necrosis; 6 of them
required resection and stoma formation and 2 underwent defimctioning jejunostomy, 7
patients had multiple perforations and multiple resections and stomas were performed, 4
patients had single perforation and underwent resection and primary anastomosis, 3 cases
had colonic perforation and localized peritonitis and underwent colonic resection and
proximal colostomy and 23 cases had localized collections that were drained
Postoperatively, 27 patients (50.9%) died, 6 patients had stoma! prolapse, 10 had wound
infection and 3 of them had wound dehiscence with a complication rate among survivors of
61.5%.li could be concluded that laparoscopy could spare NTL with accuracy 100% in
advanced cases and define cases required simple drainage with accuracy 90.5%. Test validity
criteria showed a significant (Pc 0.05) difference in favor of laparoscopy compared to
presence of hi. Int. grade III, (X2=4.2), PVA, e =7.8) and thrombocytopenia, (X=3.18).
Using the receiver operating characteristic (ROC) curve analysis judged by the area under the
curve (AUC) revealed that laparoscopy is highly sensitive and specific diagnostic modality
with AUC=1 helping in surgical decision-making to abandon laparotomy. It could be
concluded that preoperative bedside laparoscopy could spare laparotomy in cases with
advanced NEC with accuracy 100%. |
