Ribeiro João Victor, Salamonde Julia Daudt de Faro, Perin João Pedro Serrão, Faci Rafael Ricieri Betti, Vieira Maithe Gravina Bertoldo, Saliba Giovanna Brandão, Bragagnolo Ramiro Ananias, Carvalho Clara Souza, de Barros Rogerio Fortunato
General Surgery Students Interest Group, Faculdade São Leopoldo Mandic, Campinas, SP, Brazil.
Department of Pediatric Surgery, Faculdade São Leopoldo Mandic, Campinas, SP, Brazil.
Am J Case Rep. 2025 Aug 21;26:e947801. doi: 10.12659/AJCR.947801.
BACKGROUND Necrotizing enterocolitis (NEC) is a prevalent, life-threatening gastrointestinal disease in premature neonates, characterized by intestinal inflammation, ischemia, and potential perforation. Protective measures such as ostomies of various types are a strategy to help patients during recovery from postoperative complications. Protective jejunostomy (PJ) in such cases aims to minimize intraluminal pressure and protect distal anastomoses or compromised bowel segments. However, the optimal timing for closure remains a matter of debate, between balancing bowel rest and avoiding complications associated with prolonged ostomies. CASE REPORT We report an unusual case of a 6-month-old female patient, who presented with NEC and extensive intestinal compromise. Emergency laparotomy revealed multiple areas of bowel perforation and partial ischemia without perfusion. Surgical management included selective resection of non-viable bowel segments, primary closure of smaller perforations, creation of a PJ, and a distal ileostomy. The "clip and drop" technique was not used; instead, distal bowel patency was confirmed by a second intraoperative assessment and through intestinal saline solution injection on the tenth postoperative day due to high stoma output and persistent hydroelectrolyte imbalance. Postoperatively, the patient developed 2 new ileal perforations, requiring reoperation. Following the third surgical intervention, the patient demonstrated gradual recovery without major complications, followed by elective ileostomy closure after 6 months. CONCLUSIONS This case highlights the complexity of the surgical option and timing of PJ closure in complicated NEC in a 6-month-old female patient. Early closure can mitigate complications related to the stoma but carries the risk of compromising the fragile and recovering intestine. Decision-making must be careful and individualized, balancing the risks and benefits.
坏死性小肠结肠炎（NEC）是早产儿中一种常见的、危及生命的胃肠道疾病，其特征为肠道炎症、缺血和潜在的穿孔。诸如各种类型造口术等保护措施是帮助患者从术后并发症中恢复的一种策略。在这种情况下，保护性空肠造口术（PJ）旨在使腔内压力最小化，并保护远端吻合口或受损肠段。然而，关闭造口的最佳时机仍存在争议，需要在肠道休息与避免与长期造口相关的并发症之间进行权衡。
我们报告了一例不寻常的病例，一名6个月大的女性患者，患有NEC且肠道广泛受损。急诊剖腹探查发现多个肠穿孔区域和部分缺血且无灌注。手术治疗包括选择性切除无活力的肠段、较小穿孔的一期缝合、创建PJ以及远端回肠造口术。未使用“夹闭并丢弃”技术；相反，由于造口排出量高和持续的水电解质失衡，在术后第10天通过第二次术中评估和肠内注射生理盐水确认远端肠管通畅。术后，患者出现2处新的回肠穿孔，需要再次手术。在第三次手术干预后，患者逐渐康复且无重大并发症，随后在6个月后择期关闭回肠造口。
本病例突出了一名6个月大女性患者复杂NEC中PJ关闭的手术选择和时机的复杂性。早期关闭可减轻与造口相关的并发症，但有损害脆弱且正在恢复的肠道的风险。决策必须谨慎且个体化，权衡风险和益处。
