A prospective evaluation of intestinal stenosis following necrotizing enterocolitis.

In a retrospective study, we noted a 25% incidence of colonic stenosis following medical management of necrotizing enterocolitis (NEC). From March, 1980 to March, 1982, we performed routine contrast enemas to prospectively identify the incidence of colonic stenosis following medical management for NEC. Three to four weeks following recovery from the acute phase of NEC 28 infants were prospectively evaluated by contrast enema for post-NEC stenosis. Ten of the 28 infants had one or more sites of colonic stenosis (36%). Four infants were symptomatic when the contrast enema was performed and underwent colonic resection. Three of the six asymptomatic infants developed symptoms requiring surgery within 33 days following hospital discharge. Therefore, seven of the ten infants with post-NEC stenosis required segmental colectomy. Three patients with colonic stenosis have remained asymptomatic and are being followed on an outpatient basis. The weight gain in these three infants has been steady and has paralleled a normal growth curve. The data from this study demonstrate that: (1) the incidence of post-NEC colonic stenosis is 36%; (2) patients with colonic stenosis initially may not have symptoms but may become symptomatic after hospital discharge; (3) the sites of stenosis frequently are located in the left colon; and (4) normal weight gain can occur despite the presence of colonic stenosis. Because of the above findings, we recommend routine contrast enemas in all patients with NEC who have had successful medical management.