Peritoneal drainage versus laparotomy in necrotizing enterocolitis: A continued asked question

Introduction Necrotizing enterocolitis (NEC) is a severe surgical problem affecting mainly premature neonates (low birth weight and short gestational age neonates). Because of the severe deterioration in their general condition, some babies are subjected to formal laparotomy as a definitive treatment whereas others cannot tolerate this operative decision and may die if operated. Therefore, these poor babies may be subjected to bedside drainage with local anesthesia or sedation. Surprisingly, some of these neonates who undergo primary peritoneal drainage survive. This led us to compare both methods to identify a definitive management of this serious problem. Patients and methods Fifty-six cases who presented with surgical NEC were studied during the period from March 2013 to March 2016. They were subdivided into two groups. Group A included cases treated by peritoneal drainage. Group B included cases treated by laparotomy. All cases had plain erect abdomen, abdominopelvic ultrasound, complete blood count, C-reactive protein, blood culture, and arterial blood gases. We inserted a central venous catheter in all cases and total parenteral nutrition was planned. Results The mean age of the babies at presentation was 10 days. The mean gestational age in group A was 31.9 weeks, whereas in group B it was 31.8 weeks. The mean body weight was 1.7 and 1.6 kg in groups A and B, respectively. Six babies in group A died during the study, whereas seven babies died in group B. Conclusion Primary peritoneal drainage may be a reasonable line of treatment in neonates with NEC with good general condition, taking into consideration the possibility of traditional laparotomy if needed.