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Klin Padiatr 2013; 225(01): 24-28
DOI: 10.1055/s-0032-1331724
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Necrotizing Enterocolitis After Open Cardiac Surgery for Congenital Heart Defects – A Serious Threat

Nekrotisierende Enterokolitis als gefürchtete Komplikation nach operativer Korrektur angeborener Herzfehler im Neugeborenenalter
S. Kargl
1   Department of Pediatric Surgery, Women’s and Children’s Hospital Linz, Linz, Austria
,
R. Maier
2   Pediatric Cardiac Surgery, General Hospital Linz, Linz, Austria
,
R. Gitter
3   Pediatric Cardiology, Women’s and Children’s Hospital Linz, Linz, Austria
,
W. Pumberger
1   Department of Pediatric Surgery, Women’s and Children’s Hospital Linz, Linz, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
17 January 2013 (online)

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Abstract

Objective:

Neonates with congenital heart disease are at risk to develop necrotizing enterocolitis (NEC). Especially in the postoperative period after correction of a congenital heart defect this intestinal inflammatory disease can be a potentially life-threatening complication. The purpose of this case series is to define the specific features of NEC in the postoperative situation, with emphasis on diagnostic difficulties.

Patients and Methods:

Medical records of neonates developing severe NEC in the postoperative period after surgical correction of a congenital heart defect from 2008 to 2011 were reviewed and compared.

Results:

7 neonates with NEC after surgical correction of a congenital heart defect were identified. In all 7 patients typical radiologic findings of NEC were missing. Diagnosis was late in all 7 cases; 5 patients already had intestinal perforation. In 3 patients NEC successfully managed before surgical correction of the congenital heart defect dramatically relapsed in the postoperative period. 2 patients showed intestinal mucormycosis, an entity not clearly differentiated from NEC. Due to progressed disease at diagnosis all patients required extensive surgical procedures; 2 of them subsequently died.

Conclusion:

In the postoperative situation after surgical correction of a congenital heart defect diagnosis of NEC might be challenging. The general condition of these children complicates clinical examination and characteristic radiologic signs are absent. Late diagnosis and exclusive pathogens cause high morbidity and mortality.

Zusammenfassung

Hintergrund:

Neugeborene mit kongenitalen Herzfehlern haben ein erhöhtes Risiko eine nekrotisierende Enterokolitis (NEK) zu entwickeln. Besonders in der postoperativen Phase nach operativer Korrektur des Vitiums ist die NEK eine potentiell lebensbedrohliche Komplikation. Fragestellung Mit dieser Fallserie demonstrieren wir die Besonderheiten und vor allem die diagnostischen Schwierigkeiten der NEK nach operativer Korrektur angeborener Herzfehler in der Neonatalperiode.

Patienten und Methodik:

Die Krankenakten aller Patienten, die zwischen 2008 und 2011 in der postoperativen Phase nach Korrektur eines Vitiums eine NEK entwickelten wurden begutachtet und verglichen.

Ergebnisse:

Wir identifizierten 7 Neugeborene mit NEK nach operativer Korrektur eines kongenitalen Herzfehlers. In allen 7 Fällen fehlten die charakteristischen radiologischen Zeichen der NEK. Die Diagnose wurde in allen Fällen spät gestellt, weshalb 5 Patienten bei Diagnosestellung bereits eine intestinale Perforation entwickelt hatten. Bei 3 Patienten kam es nach präoperativ erfolgreich konservativ behandelter NEK in der postoperativen Phase zu einem fulminanten Rezidiv dieser entzündlichen Darmerkrankung. Bei 2 Patienten fand sich eine intestinale Mukormykose – eine Pilzerkrankung die der NEK zugeordnet wird. Aufgrund des fortgeschrittenen Krankheitsstadiums bei Diagnose benötigten alle Patienten ausgedehnte chirurgische Eingriffe, 2 überlebten die schwere NEK nicht.

Schlussfolgerungen:

Die Diagnose einer NEK ist in der postoperativen Situation nach Korrektur eines Vitiums besonders schwierig. Der Allgemeinzustand der Kinder erschwert die klinische Untersuchung, die charakteristischen radiologischen Zeichen fehlen. Dies führt zu einer hohen Morbidität und Mortalität.

Schlüsselwörter

nekrotisierende Enterokolitis - angeborene Herzfehler - Kinderherzchirurgie - intestinale Minderdurchblutung

Key words

necrotizing enterocolitis - congenital heart defect - open cardiac surgery - intestinal ischemia
 

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