Use of high jejunostomy in extensive NEC.

Use of a stoma above involved bowel has been suggested as an option in the infant found to have NEC of an extent which precludes resection. This achieves total decompression and places the involved bowel at rest. A 1-mo-old infant developed NEC after a week of diarrhea. Pneumoperitoneum prompted exploration and involvement of the entire small bowel with a perforation of the ileum was present. The perforation was sutured and a jejunostomy performed within 6 in of the duodenum. Recovery was smooth. After 3 wk of central IV alimentation weight gain was steady and a contrast study ruled out stenosis of the colon. The stoma was resected and bowel continuity restored. Subsequent growth and development have been normal. This approach offers promise in extensive NEC and should be considered early in a patient who fails to improve promptly with intensive medical management.