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Pediatr Surg Int (1992) 7:394-395

Pediatric Surgery
International © Springer-Verlag 1992

Case report

Perforated enterocyst: a late complication of neonatal necrotizing enterocolitis
Daniel A. Ladin 1, David P. Campbell 2, and C. Peter Crowe 2
Departments of 1 General Surge12¢ and 2 Pediatric Surgery, University of Arizona, USA Accepted 15 July 1991

Abstract. Infants with necrotizing enterocolitis (NEC) may develop late sequelae including intestinal stenoses, enteric fistulae, abscess formation, recurrent NEC, cholestasis, malabsorption, short gut syndrome, and enterocyst formation [4]. A case is reported where a child developed an enterocyst arising from the proximal aspect of a defunctionalized Hartmann's pouch 2 years after ileostorey and near-total colectomy. The patient presented with fever and abdominal pain and distension, and was successfully treated by excision of the perforated enterocyst. This rare complication demonstrates that problems may develop in a defunctionalized bowel segment long after primary therapy for NEC.

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Key words: Enterocyst - Intestinal stenosis - Necrotizing
enterocolitis

Case report
A 2-year-old black male was admitted with vomiting and decreased frequency of stools. He then developed fever to 39 ° C with progressive abdominal distension and tenderness. Abdominal films demonstrated dilated bowel loops suggesting ileus or obstruction. He had been treated

Fig. 1. Intraperitoneal colonic enterocyst arising from retroperitoneal strictured Hartmann's pouch

Discussion
Late complications of NEC have been described after operative or nonoperative management [7]. Intestinal stenosis is the most common of these, with an overall incidence of approximately 30% ( 6 % - 4 2 % ) [4, 7, 6, 3, 8]. One prospecitve study using radiocontrast enemas demonstrated a 36% incidence of intestinal stenosis 3 - 4 weeks after the acute phase of NEC [8]. Most lesions become symptomatic within 2 months of the acute phase [8, 9], however, some remain quiescent or oven improve or resolve completely [10]. Rarely, patients can develop late symptoms from stenotic lesions 1 - 2 years after the acute phase [3, 9]. Presenting symptoms may include distension, bilious vom-

for necrotizing enterocolitis (NEC) as a neonate with near-total colectomy,ileostomy, and a Hartmann's pouch extending to the peritoneal reflection.At celiotomya perforatedenterocystwas found originating at the proximal portion of the Hartmann's pouch and extending approximately 10 cm cephalad in its greatest dimension to the inferior pole of the left kidney (Fig. 1). The cyst containedclear mucoid material and its wall containedcolonic epithelium.

Correspondence to: Daniel A. Ladin, Plastic and Reconstructive Surgery, 2130 Taubman Center, Box 0340, 1500 East Medical Center Drive, Ann Arbor, Michigan 48 109, USA

Rajadurai VS. Hanson JB. Ross MN. Mancer K (1981) Intestinal stricture after necrotizing enterocolitis. Tyson KRT. Janik JS.808 2. Tonkin ILD. Aust Paediatr J 24: 366-368 10. inadequate growth. Hayden CK. Askin FB. Capp MP. Findings at celiotomy can include enterocolic fistula and pericolic or retroperitoneal abscess [2]. Shackleford G (1976) Intestinal stricture in necrotizing enterocolitis. 2]. with lesions arising in the distal rectosigmoid in only 1% o f patients [3]. Janik JS. Ford WDA (1988) Late onset bowel stenoses after neonatal necrotizing enterocolitis. formula intolerance. Ermocilla R (1978) Spontaneous resolution of colonic strictures caused by necrotizing enterocolitis: therapeutic implications. Our report o f a perforated enterocyst underscores the potential for acute sequelae to arise in a defunctionalized bowel segment long after primary therapy for NEC.111 5. Stenoses occur most frequently in the splenic flexure and descending colon. Sen S. Chang JHT (1989) A standard of comparison for acute surgical necrotizing enterocolitis. Richardson CJ. Musemeche CA (1989) Necrotizing enterocolitis of the neonate. Ball TI. obstipation. Lobe TE (1982) A prospective evaluation of intestinal stenosis following necrotizing enterocolitis. Wayne ER. J Pediatr Surg 11: 319-327 . J Pediatr Surg 8:479-486 6.395 iting. Bell MJ. Ternberg L. Ricketts RR (1984) Surgical therapy for necrotizing enterocolitis (1984) Ann Surg 200:653-657 7. Lloyd DA. Three cases o f enterocyst formation between stenoses in defunctionalized colon after diverting enterostomy have been reported. Burrington JD. 3. Am J Radiol 147:806 . Schwartz MZ. Am J Roentgenol 130: 1077-1081 References 1. Hunter TB. Kosloske AM. or sepsis [8. J Pediatr Surg 17: 764-770 9. J Pediatr Surg 24: 998-1002 8. Cywes S (1973) Intestinal stenosis and enterocyst formation as late complications of neonatal necrotizing enterocolitis. Wyly JB (1986) Enterocyst formation: a late complication of neonatal necrotizing enterocolitis. Ein SH. Firor H. melena. Bjelland JC. McAllister W. J Pediatr Surg 16:438-443 4. Clin Perinatol 16:97 .