Successful treatment of giant multiple enteroatmospheric fistulas in an extremely premature infant using staged procedures. A case report and literature review

Necrotizing enterocolitis (NEC) remains a leading cause of morbidity in extremely low birth weight neonates. We report a complex surgical management of a 560 g preterm infant with NEC complicated by intestinal perforation, enteroatmospheric fistula, and prolonged open abdomen. Management included negative pressure wound therapy combined with stoma bag application, prolonged total parenteral nutrition, and delayed reconstruction using multiple anastomoses and tube stomas. Final abdominal closure was achieved with absorbable mesh and skin flaps. Despite prolonged hospitalization and multiple complications, enteral autonomy was ultimately achieved. This case highlights the challenges of managing NEC-related enteroatmospheric fistulas in extremely low birth weight infants and supports the use of negative pressure wound therapy and staged reconstruction to preserve bowel length and avoid short gut syndrome.