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Nekrotisierende Enterokolitis

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Kinderchirurgie

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Zusammenfassung

Die nekrotisierende Enterokolitis (NEC) wurde erstmals 1952 in einer Publikation aus Graz durch den Pädiater Quaiser und den Pathologen Schmid unter dem Titel „Enteritis ulcerosa necroticans“ beschrieben. Es handelt sich um die häufigste, lebensbedrohliche, entzündliche Darmerkrankung bei Frühgeburten. Pathologische Bakterienbesiedelung des Darms, ischämische Darmwandschädigungen, hyperosmolare Nahrung und eine generelle Unreife der Darmschleimhautbarriere mit Translokation von intestinalen Keimen werden als Ursachen diskutiert. Die Nekrose betrifft überwiegend den unteren Dünndarm und oberen Kolonbereich. Die typischen klinischen Zeichen sind eine plötzliche Verschlechterung des Allgemeinzustandes mit aufgetriebenem und schmerzhaftem Abdomen, zunehmendem Erbrechen, blutigem Stuhlabgang und Sepsis. Radiologisch zeigen sich weite Dünndarmschlingen, intestinale Pneumatose als Zeichen der Bakterientranslokation und schließlich freie Luft im Abdomen bei Perforation. Je nach Schwere der Erkrankung werden verschiedene Stadien unterschieden. Die Behandlung besteht im Absetzten der enteralen und Beginn der parenteralen Ernährung, Antibiotikatherapie und bei zunehmendem abdominellen Befund trotz konservativer Therapie in der chirurgischen Resektion betroffener Darmabschnitte. Die Überlebensraten haben sich in den letzten 20 Jahren deutlich verbessert; die Mortalität liegt heute auch bei schweren Fällen bei 15–30%, bei extremer Frühgeburtlichkeit bei 50%. Ein entscheidender Fortschritt gelang durch konsequente prophylaktische Therapie, wodurch die Inzidenz der NEC selbst bei Frühgeburten <1500 g auf weniger als 1% gesenkt werden konnte.

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Authors and Affiliations

  1. Universitätsklinik für Kinder- und Jugendchirurgie, Medizinische Universität Graz, Auenbruggerplatz 34, 8036, Graz, Austria

    Prof. Dr. med. M. Höllwarth

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  1. Prof. Dr. med. M. Höllwarth
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Editors and Affiliations

  1. Kinderchirurgische Klinik, Universitätsklinikum München Dr. von Haunersches Kinderspital, München, Germany

    Dietrich von Schweinitz

  2. Abt. Kinderchirurgie, Medizinische Hochschule Hannover (MHH) Kinderklinik, Hannover, Germany

    Benno Ure

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Höllwarth, M. (2013). Nekrotisierende Enterokolitis. In: von Schweinitz, D., Ure, B. (eds) Kinderchirurgie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-29779-3_27

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  • DOI: https://doi.org/10.1007/978-3-642-29779-3_27

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