Adv Pediatr Surg.  2018 Dec;24(2):35-43. 10.13029/aps.2018.24.2.35.

Enterostomy Closure after Acute Abdomen in Neonate and Infant

• Yang HB
• Kim HY

• KMID: 2429799
• DOI: http://doi.org/10.13029/aps.2018.24.2.35

Abstract

The risk of acute abdomen in neonates and infants is generally increased due to advanced maternal age and neonatal intensive care unit care development. Enterostomy is a safe procedure for acute abdomen in neonates and infants. However, there is no consensus for the optimal timing of enterostomy closure (EC). A few considerations should be reviewed for deciding the timing of stoma closure to obtain the best outcome. Distal loopography is commonly performed upon examination to ascertain the existence of a distal passage after EC, detect signs of disease-specific complications, and assess the need of surgery in addition to EC. Pathology review is also one important pre-closure consideration. When the incidence of a hypoganglionosis or an aganglionosis combined with acute abdomen is observed in neonates and infants, thorough examinations should be performed to conclusively determine whether there is no passage disturbance of the distal bowel. Refeeding not only provides information about chance to grow, electrolyte imbalance correction, and proximal and distal bowel size match, but also provides information about distal bowel passage when there is a doubtful distal loopography or pathology result. Early closure enables growth spurt with the correction of water/electrolyte imbalance. It potentially reduced medical costs, less discrepancy between proximal and distal bowel size. Some factors favoring a late stoma closure may be due to less postoperative complications, early recovery, shorter time of total parenteral nutrition after EC, and decreased length of hospitalization after the EC. Some studies have shown controversial results. In summary, a pre-closure evaluation is imperative to assure the safety of an EC. The optimal timing of an EC remains controversial. For this reason, individualized approach is needed after reviewing the general condition of each patient. Further prospective study on optimal timing of stoma closure including a randomized clinical trial is needed.

Keyword

Enterostomy; Acute abdomen; Newborn infant; Infant

MeSH Terms

Abdomen, Acute*
Consensus
Enterostomy*
Hospitalization
Humans
Incidence
Infant*
Infant, Newborn*
Intensive Care, Neonatal
Maternal Age
Parenteral Nutrition, Total
Pathology
Postoperative Complications
Prospective Studies

Figure

• 

  Fig. 1 (A) Colonic stricture after necrotizing enterocolitis. This colon study was obtained 3 month later after enterostomy formation. (B) A delayed evacuation of contrast agent with meconium-related ileus.

Reference

1. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008; 371:75–84.

2. Moon JY, Hahn WH, Shim KS, Chang JY, Bae CW. Changes of maternal age distribution in live births and incidence of low birth weight infants in advanced maternal age group in Korea. Korean J Perinatol. 2011; 22:30–36.

3. Singh M, Owen A, Gull S, Morabito A, Bianchi A. Surgery for intestinal perforation in preterm neonates: anastomosis vs stoma. J Pediatr Surg. 2006; 41:725–729.

4. de Haro Jorge I, Prat Ortells J, Albert Cazalla A, Muñoz Fernández E, Castañón García-Alix M. Long term outcome of preterm infants with isolated intestinal perforation: A comparison between primary anastomosis and ileostomy. J Pediatr Surg. 2016; 51:1251–1254.

5. Moss RL, Dimmitt RA, Barnhart DC, Sylvester KG, Brown RL, Powell DM, et al. Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation. N Engl J Med. 2006; 354:2225–2234.

6. Rees CM, Eaton S, Kiely EM, Wade AM, McHugh K, Pierro A. Peritoneal drainage or laparotomy for neonatal bowel perforation? A randomized controlled trial. Ann Surg. 2008; 248:44–51.

7. Sola JE, Tepas JJ 3rd, Koniaris LG. Peritoneal drainage versus laparotomy for necrotizing enterocolitis and intestinal perforation: a meta-analysis. J Surg Res. 2010; 161:95–100.

8. Weber TR, Tracy TF Jr, Silen ML, Powell MA. Enterostomy and its closure in newborns. Arch Surg. 1995; 130:534–537.

9. O'Connor A, Sawin RS. High morbidity of enterostomy and its closure in premature infants with necrotizing enterocolitis. Arch Surg. 1998; 133:875–880.

10. Lee J, Kang MJ, Kim HS, Shin SH, Kim HY, Kim EK, et al. Enterostomy closure timing for minimizing postoperative complications in premature infants. Pediatr Neonatol. 2014; 55:363–368.

11. Festen C, Severijnen RS. vd Staak FH. Early closure of enterostomy after exteriorization of the small intestine for abdominal catastrophies. J Pediatr Surg. 1987; 22:144–145.

12. Struijs MC, Sloots CE, Hop WC, Tibboel D, Wijnen RM. The timing of ostomy closure in infants with necrotizing enterocolitis: a systematic review. Pediatr Surg Int. 2012; 28:667–672.

13. Zani A, Lauriti G, Li Q, Pierro A. The timing of stoma closure in infants with necrotizing enterocolitis: a systematic review and meta-analysis. Eur J Pediatr Surg. 2017; 27:7–11.

14. Banerjee DB, Vithana H, Sharma S, Tsang TT. Outcome of stoma closure in babies with necrotising enterocolitis: early vs late closure. Pediatr Surg Int. 2017; 33:783–786.

15. Kang MJ, Lee J, Kim HS, Ko JS, Park KW. Determining the timing for the enterostomy repair using age-based analysis. Korean J Perinatol. 2013; 24:251–258.

16. Koivusalo A, Pakarinen M, Lindahl H, Rintala RJ. Preoperative distal loop contrast radiograph before closure of an enterostomy in paediatric surgical patients. How much does it affect the procedure or predict early postoperative complications? Pediatr Surg Int. 2007; 23:747–753.

17. Haberlik A, Höllwarth ME, Windhager U, Schober PH. Problems of ileostomy in necrotizing enterocolitis. Acta Paediatr Suppl. 1994; 396:74–76.

18. Drugsite Trust. Gastrografin side effects in detail - Drugs.com [Internet]. [place unknown]: Drugs.com;2018. cited 2018 Mar 6. Available from: https://www.drugs.com/sfx/gastrografin-side-effects.html.

19. Tanner SM, Berryhill TF, Ellenburg JL, Jilling T, Cleveland DS, Lorenz RG, et al. Pathogenesis of necrotizing enterocolitis: modeling the innate immune response. Am J Pathol. 2015; 185:4–16.

20. Raboei EH. Necrotizing enterocolitis in full-term neonates: is it aganglionosis? Eur J Pediatr Surg. 2009; 19:101–104.

21. Kubota A, Shiraishi J, Kawahara H, Okuyama H, Yoneda A, Nakai H, et al. Meconium-related ileus in extremely low-birthweight neonates: etiological considerations from histology and radiology. Pediatr Int. 2011; 53:887–891.

22. Toyosaka A, Tomimoto Y, Nose K, Seki Y, Okamoto E. Immaturity of the myenteric plexus is the aetiology of meconium ileus without mucoviscidosis: a histopathologic study. Clin Auton Res. 1994; 4:175–184.

23. Bughaighis AG, Emergy JL. Functional obstruction of the intestine due to neurological immaturity. Prog Pediatr Surg. 1971; 3:37–52.

24. Singh S, Rawat J, Wakhlu A, Kureel SN, Pandey A. Six-year retrospective analysis of colonic perforation in neonates and infants: single centre experience. Afr J Paediatr Surg. 2012; 9:102–105.

25. Koike Y, Uchida K, Nagano Y, Matsushita K, Otake K, Inoue M, et al. Enteral refeeding is useful for promoting growth in neonates with enterostomy before stoma closure. J Pediatr Surg. 2016; 51:390–394.

26. Al-Harbi K, Walton JM, Gardner V, Chessell L, Fitzgerald PG. Mucous fistula refeeding in neonates with short bowel syndrome. J Pediatr Surg. 1999; 34:1100–1103.

27. Maroulis J, Kalfarentzos F. Complications of parenteral nutrition at the end of the century. Clin Nutr. 2000; 19:295–304.

28. Lau EC, Fung AC, Wong KK, Tam PK. Beneficial effects of mucous fistula refeeding in necrotizing enterocolitis neonates with enterostomies. J Pediatr Surg. 2016; 51:1914–1916.

29. Wong KK, Lan LC, Lin SC, Chan AW, Tam PK. Mucous fistula refeeding in premature neonates with enterostomies. J Pediatr Gastroenterol Nutr. 2004; 39:43–45.

30. Pataki I, Szabo J, Varga P, Berkes A, Nagy A, Murphy F, et al. Recycling of bowel content: the importance of the right timing. J Pediatr Surg. 2013; 48:579–584.

31. Kosloske AM, Burstein J, Bartow SA. Intestinal obstruction due to colonic stricture following neonatal necrotizing enterocolitis. Ann Surg. 1980; 192:202–207.

32. Rothstein FC, Halpin TC Jr, Kliegman RJ, Izant RJ Jr. Importance of early ileostomy closure to prevent chronic salt and water losses after necrotizing enterocolitis. Pediatrics. 1982; 70:249–253.

33. Gertler JP, Seashore JH, Touloukian RJ. Early ileostomy closure in necrotizing enterocolitis. J Pediatr Surg. 1987; 22:140–143.

34. Gonzalez DO, Ambeba E, Minneci PC, Deans KJ, Nwomeh BC. Surgical site infection after stoma closure in children: outcomes and predictors. J Surg Res. 2017; 209:234–241.

35. Bethell G, Kenny S, Corbett H. Enterostomy-related complications and growth following reversal in infants. Arch Dis Child Fetal Neonatal Ed. 2017; 102:F230–F234.

36. Struijs MC, Poley MJ, Meeussen CJ, Madern GC, Tibboel D, Keijzer R. Late vs early ostomy closure for necrotizing enterocolitis: analysis of adhesion formation, resource consumption, and costs. J Pediatr Surg. 2012; 47:658–664.

37. Musemeche CA, Kosloske AM, Ricketts RR. Enterostomy in necrotizing enterocolitis: an analysis of techniques and timing of closure. J Pediatr Surg. 1987; 22:479–483.

38. Al-Hudhaif J, Phillips S, Gholum S, Puligandla PP, Flageole H. The timing of enterostomy reversal after necrotizing enterocolitis. J Pediatr Surg. 2009; 44:924–927.

39. Talbot LJ, Sinyard RD, Rialon KL, Englum BR, Tracy ET, Rice HE, et al. Influence of weight at enterostomy reversal on surgical outcomes in infants after emergent neonatal stoma creation. J Pediatr Surg. 2017; 52:35–39.

40. Veenstra M, Nagappala K, Danielson L, Klein M. Timing of ostomy reversal in neonates with necrotizing enterocolitis. Eur J Pediatr Surg. 2015; 25:231–235.