Long-Term Complications of Neonatal Necrotic Enterocolitis: Twisting of Stenosed Small Intestine
Authors: Gavrilyuk V. P. , Donskaya E. V. , Severinov D. A. 
Published: February 2023

Neonatal necrotic enterocolitis (NEC) is a nonspecific inflammatory disease of unknown etiology with multifactorial pathogenesis, which development is explained as a result of hypoperfusion of the immature intestinal mucosa of a newborn who has undergone perinatal hypoxia and, as a result, a change in blood flow in the mesenteral vascular system. This disease more often affects the intestinal wall of premature babies. In typical cases, mucosal necrosis develops in the terminal iliac and right parts of the colon, and when the process progresses, it can spread to the entire thickness of the intestinal wall, causing its perforation, so peritonitis is a frequent complication of NEC. But in addition, distant complications of NEC are distinguished, which include the development of intestinal obstruction in view of a decrease in the contractility of the intestinal wall section due to its fibrosis and, as a result, narrowing of the lumen.

We report the clinical case of surgical treatment of the twisting of stenosed portion of the ileum in a child who underwent NEC in the early neonatal period. A mother sought assistance with a child of 3 months at the Reginal Children’s Hospital (born at 28 weeks of gestation). After birth, there was a violation of the absorption of enteral nutrition (periodic posseting, bloating), blood in the stool was determined. On the 14th day of life a pediatric surgeon examined the baby: necrotizing enterocolitis II A. After stabilizing the condition (2 months), the child was transferred from the perinatal center to a pediatric hospital with a diagnosis of bronchopulmonary dysplasia, a new form, a severe course, and a period of exacerbation. At the age of 2.5 months, he was discharged in a satisfactory condition to the outpatient stage. On the 15th day from the moment of discharge (3 months of life), the mother noted the expressed anxiety of the baby, bloating, stool retention. On the 16th day from the moment of discharge during feeding, the child began to suck sluggishly, did not absorb the age norm. He was examined by a pediatrician, the consultation of a pediatric surgeon was recommended. Due to the severity of the condition, the baby was hospitalized.

In the initial examination, no data for intestinal obstruction were detected. The patient received parenteral nutrition, antibacterial therapy. Ultrasound and radiography of abdominal organs were performed daily. On the third day of observation, deterioration is noted (abdomen bloated mainly in the upper parts, soft upon with palpation, the baby was anxious, peristalsis was reduced), with ultrasound: between the loops of the enlarged intestine, an echogenic band of up to 18 mm (adhesion?) was determined, there was the liquid component between the loops. A laparotomy was performed, during the revision there was a displacement of the large intestine into the left parts of the abdominal cavity. Ten cm from the ileocecal angle, a section of the ileum with a length of up to 15 cm was found, which was like a “double trunk” wrapped at the base around its axis around a cord-like adhesive stretching to the posterior abdominal wall. Visually, the loop was dark bard in color, its walls were swollen, infiltrated, and their cartilaginous density was determined upon palpation in the contact area of the walls of the intestine. The resection of this loop was performed, end-to-end anastomosis was formed according to the method of J. Louw. After the operation, the baby received treatment in the intensive care unit, enteral feeding on day 5, on day 9, after expanding the volume of feeding, he was transferred to the department of pediatric surgery. Discharged in satisfactory condition on the 12th day after surgery.