The role of gut microflora in postoperative adaptation and necrotizing enterocolitis risk following congenital intestinal obstruction

Abstract

Congenital intestinal obstruction represents a critical surgical emergency in the neonatal period, necessitating prompt operative intervention to restore luminal patency. While the surgical correction of anatomical anomalies such as intestinal atresia, malrotation with volvulus, or meconium ileus is often successful, the postoperative course remains fraught with significant challenges. The principal hurdles include the imperative for the distal, unused intestine to achieve functional adaptation and the persistent threat of life-threatening complications, most notably necrotizing enterocolitis. This article posits that the gut microflora serves as a pivotal determinant in navigating these postoperative pathways. The initial establishment and subsequent succession of microbial communities are profoundly disrupted by the underlying obstruction and the requisite surgical trauma. This dysbiotic state can critically impair the processes of intestinal adaptation, including mucosal hyperplasia and barrier fortification, while simultaneously priming the gut for a heightened inflammatory response. Consequently, the reconstitution of a beneficial microflora postoperatively is not merely a passive outcome but an active therapeutic target. A deeper understanding of the host-microbe interactions in this vulnerable population offers a paradigm shift from solely surgical management to a more holistic approach aimed at modulating the microbiome to support adaptation and mitigate the risk of necrotizing enterocolitis.