[Surgical treatment of necrotizing enterocolitis: suspicions and dilemmas].

The acute intestinal perforation is the absolute indication for surgical treatment of neonatal necrotizing enterocolitis (NEC). Other symptoms, signs and conditions suggested as indications for surgical treatment are often unclear. Since the beginning of the treatment for NEC there have been the attempts of categorisation to clear which of the patients have really needed conservative or surgical treatment. However, these categories have not been as useful in practice as it had been expected. The problem is not resolved. The indication for surgical treatment of NEC is still based on surgeon's experience in practice. The surgical treatment of NEC is based upon resection of pathologically changed intestine. Whether it performs the primary anastomosis or enterostomy depends of surgeon's estimation which operation will cause less problems to the patient suffering already. There are the attempts to preserve bowel length modificating the operative tactics in selective cases of NEC. Careful nursing and medical care greatly reduce the severity of the disease decreasing both the associated morbidity and mortality. The treatment of NEC appearing in other entities is almost always surgical. It is almost the rule that patients in such cases belong to the group of great risk. Sometimes, in bad condition of the patient only the drainage of the peritoneal cavity is performed. Performing the resection in these cases as well as giving up of the surgical treatment is the question ethics.