ABSTRACT
Except in its earliest stages, necrotizing enterocolitis is a surgical disease that may masquerade as a medical condition, rather than the other way around. Surgery is indicated in the presence of clinical evidence of intestinal necrosis, which can include pneumoperitoneum (reflecting perforation at the site of necrosis), portal venous air (reflecting necrosis sufficient to compromise the intestinal barrier so as to allow gas to coalesce within the portal system), or failure to respond to medical management within a defined period. While most operations for NEC have included intestinal resection followed by stoma formation, there may be a role for alternative approaches, including the “clip, drop, and silo” approach, as well as the use of laparoscopy. By contrast, peritoneal drainage should be reserved for infants with spontaneous intestinal perforation (a different entity than NEC) or as a temporizing measure in infants with abdominal distention that is compromising ventilation, and would therefore be performed in order to facilitate the subsequent performance of laparotomy.
