Surgical problems in necrotizing enterocolitis in childhood.

The problem of necrotizing enterocolitis is discussed based on the experience with 24 patients. It has been found that the time factor plays an important role in the decision whether to operate. The indications for operation are intestinal perforation, threatening perforation, and penetration of a covered perforation. Operation is carried out in order to treat the peritonitis caused by perforation. The various operative methods are described and evaluated. Intestinal resection, exclusion enterostomies, and suture of the perforation may all be justified, depending on the findings at operation. The difficulties in the differential diagnosis are discussed. The importance of late complications are stressed, and it is pointed out that every case will require routine controls long after discharge from the hospital. The high mortality is directly related not to the surgical complications, but rather to the septicemia which so often develops.