Enterostomy and its closure in newborns
T. R. Weber, T. F. Tracy Jr, M. L. Silen and M. A. Powell
Department of Surgery, University School of Medicine, St Louis Mo, USA.
OBJECTIVES: To examine the morbidity and mortality in 109 newborns who
required enterostomy for intestinal necrosis, perforation, or obstruction
and to analyze the complications associated with enterostomy closure.
DESIGN: Data were collected retrospectively from hospital and office
charts. Follow-up was 1 to 6 years. SETTING: Tertiary care, newborn
intensive care unit at a children's hospital. PATIENTS: A referred sample
of 109 newborns (aged 0 to 28 days) with bowel necrosis, obstruction, or
perforation, who underwent enterostomy as part of their therapy.
INTERVENTIONS: Operative formation of any enterostomy during laparotomy for
bowel necrosis, obstruction, or perforation and subsequent closure. MAIN
OUTCOME MEASURES: Morbidity and mortality associated with newborn
enterostomy and its closure. RESULTS: Patients underwent jejunostomy (n =
31), ileostomy (n = 62), or colostomy (n = 16) for necrotizing
enterocolitis (n = 79), atresia (n = 15), idiopathic perforation (n = 8),
volvulus (n = 4), or meconium ileus (n = 3). Seventeen (16%) died
postoperatively of sepsis, respiratory distress, further necrotizing
enterocolitis, or intraventricular hemorrhage. Complications developed in
10 (34%) of the remaining 29 patients who underwent jejunostomy, whereas in
13 (26%) of 50 patients who underwent ileostomy and three (23%) of 13
patients who underwent colostomy, complications requiring revision
developed. Ninety-two patients underwent enterostomy closure 14 to 65 days
after enterostomy. Four later died of continuing respiratory distress and
liver failure. Fifteen (56%) of 27 jejunostomies, 28 (57%) of 49
ileostomies, and nine (75%) of 12 colostomies were closed uneventfully,
whereas two jejunostomy and eight ileostomy closures dehisced, requiring
repeated enterostomy and secondary closure. All 10 children with
anastomotic dehiscence had necrotizing enterocolitis originally, showed
poor weight gain (< 30% per month), and had low serum albumin levels (22
+/- 3 g/L) compared with children with successful primary closure (> 30%
weight gain per month; serum albumin level, 37 +/- 6 g/L; both Ps <
.05). CONCLUSION: These data show that enterostomy is a potentially morbid
condition in the newborn and is prone to complications but should be closed
only when the child is in satisfactory nutritional condition.
