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21/59. Necrotizing enterocolitis presenting in the Emergency Department: case report and review of differential considerations for vomiting in the neonate.

    Historically, most of the acute complications of prematurity have occurred in the neonatal intensive care unit, not in the Emergency Department (ED). It is becoming increasingly common, however, for premature infants to be discharged from the hospital before they have reached a postconceptual age of 40 weeks. Such infants remain at relatively increased risk for a variety of complications of prematurity and may present to the ED in their first month of life. To highlight its symptomatology and review its management, we present the case of an infant presenting back to the ED with coffee ground emesis and fulminant necrotizing enterocolitis.
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keywords = necrotizing
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22/59. An unusual late complication of necrotizing enterocolitis.

    Necrotizing enterocolitis (NEC) now is managed frequently successfully without surgical intervention. NEC may result in strictures, which present after the acute inflammatory process has resolved. Strictures usually present as obstruction in the first year or two of life. A case report is presented of an 11-year-old child who had symptoms from a previously undiagnosed NEC stricture as a result of pica when coins obstructed the stricture. As treatment of NEC continues to improve, more and later complications of this disease can be expected. J Pediatr Surg 36:1853-1854.
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ranking = 4
keywords = necrotizing
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23/59. Ileoileal intussusception and ileal stricture associated with necrotizing enterocolitis in a premature infant: report of a case.

    A 630-g male infant developed presumed necrotizing enterocolitis (NEC) after fungal enteritis that resulted in subsequent fungal septicemia associated with pneumoperitoneum on the 9th day of life. Urgent percutaneous Penrose drainage was required. During the operation on the 14th day, an ileoileal intussusception and an ileal stricture were found with perforations on each oral side of the lesions. The distinction between NEC and intussusception in premature infants when they coexist can be difficult, as these conditions share common symptoms. The relation between ischemic injury and dysmotility of the intestine is also discussed. The similarity of intrauterine fetal distress and NEC in premature infants, as seen in the present case of the intussusception associated with focal NEC, suggests that mesenteric and enteric vascular ischemia could be one trigger of intussusception in neonates.
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keywords = necrotizing
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24/59. Intraoperative colonic lavage in a premature infant: a case report.

    Left-sided colonic obstruction in the neonate traditionally is managed with a multistaged defunctioning colostomy and resection. In adults, one-stage primary anastomosis has become increasingly popular with the use of on-table antegrade colonic lavage. In infants, and especially in premature neonates, enterostomies pose significant morbidity. O'Connor and Sawin reported a 68% complication rate in 50 infants with necrotizing enterocolitis who had survived until the time of enterostomal closure. This case discusses a modified application of on-table colonic lavage in the management of an obstructing sigmoid stricture in a premature infant.
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keywords = necrotizing
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25/59. Marked (24-fold) elevation of peritoneal cavity drainage fluid vascular endothelial growth factor after successful "patch, drain, and wait" approach for extensive midgut necrosis in a newborn.

    In a current publications, it has been suggested that hypoxia-triggered "good angiogenesis" involving hypoxic up-regulation of vascular endothelial growth factor (VEGF) molecules, genes, and receptors is likely responsible in a major way for the remarkable gut and patient salvage experience associated with use of the "patch, drain, and wait" (PD&W) surgical approach to perforated necrotizing enterocolitis and midgut volvulus (MGV) with extensive ischemia/necrosis. We report a case in which extensive ischemia/necrosis in a newborn with gastroschisis (likely MGV-induced) was managed successfully by PD&W with an associated marked (24-fold) elevation of VEGF in drainage fluid at 7 days post-initiation of PD&W.
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26/59. Clostridial enteritis necroticans versus secondary clostridial infection superimposed upon ischemic bowel disease.

    Clostridial enteritis necroticans, or pig-bel, as seen in papua new guinea, is a necrotizing, segmental gangrene of the small intestine occurring in members of a malnourished population, who become ill after consuming large quantities of pork contaminated with Type C. clostridium perfringens. We report a case of possible Clostridial enteritis necroticans with concomitant ischemic intestinal disease secondary to superior mesenteric arterial thrombosis occurring in a 53-year-old woman with a long history of diabetes mellitus, hypertension, and peripheral vascular disease. The differential diagnosis and the pathogenesis of C. perfringens enteritis necroticans are discussed.
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keywords = necrotizing
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27/59. octreotide-induced hypoxemia and pulmonary hypertension in premature neonates.

    The authors report 2 cases of premature neonates who had enterocutaneous fistula complicating necrotizing enterocolitis. Pulmonary hypertension developed after administration of a somatostatin analogue, octreotide, to enhance resolution of the fistula. The authors discuss the mechanism of the occurrence of this complication and recommend caution of its use in high-risk premature neonates.
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28/59. shigella flexneri bacteremia in a child.

    We report an unusual and lethal case of shigella flexneri septicemia in an 8-year-old Saudi handicapped child from a social home presenting with severe toxic megacolon and acute abdomen secondary to fulminant necrotizing enterocolitis.
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29/59. Late graft loss after intestinal transplantation in an adult patient as a result of necrotizing enterocolitis.

    A 50-year-old recipient of an intestinal and coecal graft with sudden onset of abdominal distention and pain, lack of bowel movements, and vomiting after closure of the diagnostic ostomy 7 months after transplantation is reported. A plain abdominal radiograph revealed pneumatosis intestinalis. An angiography excluded obstruction of large vessels, however, with absent microcirculation of the intestine. Upper gastrointestinal endoscopy showed extensive ulcerative enteritis with several spontaneous perforations. The patient underwent exploration demonstrating a nonviable intestine. The entire necrotic intestine was removed. Vascular thrombosis was excluded. Clinical data, and macroscopic and histologic features of the intestinal graft were diagnostic for necrotizing enterocolitis (NEC). Though there has been evidence for the occurrence of NEC not only in premature infants but even in older infants, children and adolescents, the presented case is, to our knowledge, the first report of NEC as etiology of late graft loss after intestinal transplantation in an adult recipient.
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ranking = 5
keywords = necrotizing
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30/59. Pump implantation for intrathecal baclofen infusion after laparotomy for necrotizing enterocolitis.

    Necrotizing enterocolitis (NEC) and spastic cerebral palsy are both familiar complications of prematurity. Children who are otherwise candidates for intrathecal baclofen infusion occasionally have long, transverse, right midabdominal laparotomy incisions from past management of NEC, and these incisions may interfere with selection of a site for pump implantation. Successful pump implantation immediately beneath a laparotomy incision was accomplished using a modification of the popular subfascial technique.
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ranking = 4
keywords = necrotizing
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