A Case of Short Bowel Syndrome after Repeated Resection of Crohn's Disease
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Abstract:
症例は51歳男性。39歳時, 右下腹部痛で発症。腸閉塞症状が改善しないため近医で開腹。術後の病理検査でクローン病の確定診断がなされた。再度, 腸閉塞症状出現したため回腸部分切除の後, 当院内科に紹介された。成分栄養療法にて約7年間比較的良好に経過観察していたが, 平成7年2月, 小腸穿孔を生じ緊急手術。小腸部分切除術を行った。その後も狭窄, 出血, 瘻孔形成と多彩な病態を呈し, それぞれ小腸部分切除術を余儀なくされた。最終的に残存小腸は, 60cmとなり, 短腸症候群の状態となった。術後は, 低濃度の成分栄養療法を開始するとともに, Total Parenteral Nutrition (TPN) によるHome-Hyperalimentationも考慮し静注ポートの挿入術を行った。現在, 術後1年を経過しているが, 内科的に経過観察中である。Keywords:
Short Bowel Syndrome
Bowel resection
Intestinal resection
Crohn disease
Advances in long‐term venous access devices and in parenteral nutrition solutions have made it possible for patients with severe short bowel syndrome to survive and to live in our society. The spectrum of this disease is such that some patients may be able to lessen their dependence or even become free from parenteral therapy. This review will discuss the role of nutrition support in the patient with short bowel syndrome. (Journal of Parenteral and Enteral Nutrition 15: 93–101, 1991)
Short Bowel Syndrome
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Short bowel syndrome in adults occurs as a result of massive small intestinal resection commonly due to severe Crohn's disease, volvulus or tumors. Diarrhea and weight loss are hallmarks of malabsorption which are aggravated if the colon is removed along with the small intestinal resection. Enteral nutrition autonomy is difficult to achieve in such cases of malabsorption where parenteral nutrition are required more often than not. We report a case of short bowel syndrome with severe malabsorption following extensive small bowel removal. The patient eventually underwent intestinal rehabilitation surgery and achieved independence from parenteral nutrition.
Short Bowel Syndrome
Intestinal resection
Bowel resection
Enteral administration
Malabsorption syndromes
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The short bowel syndrome (SBS, or simply short gut) is the most common cause for the chronic intestinal failure (CIF). The purpose of the study was to present the results of treatment of infants at risk for the development of post-resection SBS and the formation of CIF. Research materials and methods: 22 children threatened by the formation of post-resection SBS were treated in the Surgical Department of Newborns and Infants of the National Medical Research Center for Children’s Health (Moscow, Russia) from 2017 to 2021. Results: All patients have undergone the surgical treatment. The scope of the surgical intervention included adhesiolysis with the imposition of an interintestinal anastomosis. Simultaneous imposition of multiple interintestinal anastomoses (more than 4) was performed in 7 patients (32%). As a result, the CIF formation was avoided in 8 patients (36%) by maintaining the total length of the remaining small intestine. The follow-up period ranged from 12 to 46 months. Currently, 2 patients (9%) receive partial parenteral nutrition, and in 17 patients (77%) it was possible to achieve completely autonomous enteral nutrition. A lethal outcome was stated in 3 patients (14%) due to the development of a catheter-associated infection. Conclusion: in the course of this work, the principles of surgical treatment of patients threatened by the development of post-resection SBS and the formation of CIF were developed. Adequate parenteral and enteral nutrition can optimize intestinal adaptation and improve the nutritional status of the pediatric patient.
Short Bowel Syndrome
Intestinal Failure
Enteral administration
Intestinal resection
Bowel resection
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Aim of the study is to analyse physiopathological implications of massive intestinal resection and factors affecting prognosis in patients with short bowel syndrome. Twenty massive intestinal resections were performed. The causes of bowel resection were: intestinal infarction (11 cases), Crohn's disease (5 cases), small bowel volvulus (4 cases). All intestinal resections were more than 50-60% of the intestinal length. In eighteen patients intestinal anastomosis was performed immediately. In all the patients postoperative therapy with parenteral nutrition (PN) was performed. The operative morbidity and thirty-day mortality were respectively 30% (6 cases) and 35% (7 cases). The diarrhea was the dominant symptom. The average weight was 20% lower compared to the initial weight. The length of residual small bowel and type of anastomosis strongly affect survival of patients underwent massive intestinal resections. Parenteral nutrition (PN) has great importance in postoperative treatment. A useful treatment, in severe short bowel syndrome, can be small bowel transplantation.
Short Bowel Syndrome
Intestinal resection
Bowel resection
Bowel infarction
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Massive small bowel resection causes short bowel syndrome, manifested by signs and symptoms of malabsorption and by short digestion and transient times. A case of the syndrome is presented, in which an infant had massive bowel resection with interposition of the colon performed for volvulus. The signs of volvulus appeared only a few hours after birth.
Short Bowel Syndrome
Bowel resection
Intestinal resection
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Intestinal failure can occur when a large portion of the small intestine has been surgically removed resulting in short bowel syndrome, a newborn has an abnormal intestine, or in cases of intrinsic bowel disease, such as Crohn's disease or motility disorder. Diarrhea is inevitable for patients who have had extensive small intestinal resection and have developed short bowel syndrome. Almost all patients with short bowel syndrome at one time or another need parenteral nutrition, or intravenous fluid and electrolyte therapy. Although the need for parenteral nutrition and electrolyte therapy may be transient, intermittent, or chronic, it is often life-sustaining therapy. This chapter provides examples of total parenteral nutrition order forms, component composition, and suggested monitoring blood work and additive routines for the adult population. Intestinal transplantation has become a life-saving treatment that can be considered for patients with irreversible intestinal failure who cannot be maintained on parenteral nutrition.
Short Bowel Syndrome
Intestinal Failure
Intestinal resection
Intestinal motility
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Intestinal lengthening is considered to be one of the most effective surgical interventions to improve the deleterious sequelae of short-bowel syndrome. To assess the efficiency of bowel-lengthening procedures in short-bowel syndrome, an animal model was created in minipigs that show malnutrition, weight loss and small-bowel dilatation. Group 1 consisted of three animals with a 95% distal intestinal resection leaving 15 cm of ileum. Group 2 comprised six animals with a 95% distal intestinal resection leaving only 5 cm of ileum, and group 3 consisted of three animals with a 95% distal intestinal resection leaving 5 cm of ileum and construction of a distal small-bowel stenosis by temporary banding. In group 1 there was a significant increase in length of residual bowel at terminal laparotomy at 10 weeks and a significant difference for protein and potassium. No bowel dilatation occurred and no animal lost weight. Group 2 animals showed a continuous loss of weight after the intestinal resection and significantly different values in animal profile were found at 10 weeks but no significant difference in length or in diameter of the residual bowel. In group 3, all animals demonstrated a significant dilatation of the residual small bowel at 1 week when the stenosis was resected and bowel continuity restored. We conclude that in piglets a 95% distal intestinal resection leaving 5 cm of ileum leads to a short-bowel syndrome with malnutrition and weight loss, but no intestinal dilatation. To provoke an additional intestinal dilatation, creation of a distal stenosis is mandatory. Animals of group 3 represent a suitable model to assess the efficacy of short/bowel lengthening procedures.
Short Bowel Syndrome
Bowel resection
Intestinal resection
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Short Bowel Syndrome
Glucagon-like peptide-2
Enteral administration
Intestinal resection
Bowel resection
Jejunum
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Introduction. The survival rate of children with chronic intestinal failure (IF), a special case of which is short bowel syndrome (SBS), is increasing nowadays. The experience of a 4-stage system of care for children with chronic intestinal failure (IF) and short bowel syndrome (SBS) developed in Children’sCityHospital named after N. F. Filatov is presented. Objectives. The aim was to identify prognostic markers for intestinal adaptation (IA) in children with an extended (more than50 cm) resections of the intestine. Methods. The outcomes were evaluated in 75 children one year after resection and its relations to the preserved small intestine length, extension and cause of resection. Results. Survival of children after 1 and 3 years was 87–89%. The proportion of those who have reached IA was higher (38%) in children with more than60 cm remaining intestine in comparing to those who have less than30 cm and 30–60 cm of intestine (14.5–15%) (p <0.05. After combined resections of intestine and colon more children were dependent on PN (90%) then after intestinal (46%) or colon resections (41%) (p <0.05). Children with acute strangulation and intestinal malformations better achieved IA (50% and 44%) compared with those who underwent resection for necrotizing enterocolitis or diff intestinal neuroand myopathies (0% of IA by 1 year after resection) (р<0,05). By 1 year of following up (N=75) 25% achieved IA, 46% remained dependent on the PN, by 3 years (N=32) 44% achieved IA, 39% were dependent on PN. Conclusion. The remaining intestinal length, extension of resection and the underlying disease infl on 1-year prognosis in children with intestinal resections. Increasing in those who have achieved AI in the course of time allows to conclude that children with IF and SBS have a rehabilitation potential and the developed RP is eff in such patients.
Short Bowel Syndrome
Intestinal resection
Necrotizing Enterocolitis
Large intestine
Bowel resection
Intestinal Failure
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This study was designed to asses the clinical course of five children with a short bowel syndrome after massive intestinal resection during neonatal period. On the basis of their experience the authors analyze some properties that may be advantageous in this syndrome and discuss the most important factors, including enteral feeding at an early postresection stage, which influence a full development of the small bowel adaptive mechanisms. They point out that so called "short gut colitis", sometimes occurring during advancement of enteral nutrition, can be successfully treated by sulphasalazine. The authors come to the conclusion that the prognosis for newborn infants undergoing an excessive bowel resection is far well thanks to enhancement of the intestinal adaptation by a combination of a long-term parenteral nutrition with enteral feeding.
Short Bowel Syndrome
Enteral administration
Intestinal resection
Bowel resection
Intestinal Failure
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