Intestinal microbial and metabolite profile in infants with small bowel stomas after bowel resection
Hannah G. PiperMichael Bording‐JorgensenSimona VeniaminZhengxiao ZhangR G Suarez SuarezHeather ArmstrongJason A. SilvermanEytan Wine
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Abstract Background Infants with small bowel stomas (SBstoma) frequently struggle with absorption and rely on parenteral nutrition (PN). Intestinal absorption is difficult to predict based solely on intestinal anatomy. The purpose of this study was to characterize the microbiota and metabolic by‐products within stoma effluent and correlate with clinical features and intestinal absorption. Methods Prospective cohort study collecting stoma samples from neonates with SBstoma ( N = 23) or colostomy control ( N = 6) at initial enteral feed (first sample) and before stoma closure (last sample). Gut bacteriome (16S ribosomal RNA [rRNA] sequencing), short‐chain fatty acids (SCFAs) and bile acids (BAs) were characterized along with volume and energy content of a 48 h collection via bomb calorimetry (last sample). Hierarchical clustering and linear regression were used to compare the bacteriome and BAs/SCFAs, to bowel length, PN, and growth. Results Infants with ≤50% small bowel lost more fluid on average than those with >50% and controls (22, 18, 16 mL/kg/day, p = 0.013), but had similar energy losses (7, 10, 9 kcal/kg/day, p = 0.147). Infants growing poorly had enrichment of Proteobacteria compared to infants growing well (90% vs. 15%, p = 0.004). An increase in the ratio of secondary BAs within the small bowel over time, correlated with poor prognostic factors (≤50% small bowel, >50% of calories from PN, and poor growth). Conclusion Infants with SBstoma and poor growth have a unique bacteriome community and those with poor enteral tolerance have metabolic differences compared to infants with improved absorption.Keywords:
Short Bowel Syndrome
Bowel resection
Intestinal resection
Short Bowel Syndrome
Bowel resection
Attendance
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Complex gastroschisis with bowel necrosis poses an operative challenge. Surgeons must weigh the decision between resection versus preservation of ischemic bowel. As one of the leading causes of short bowel syndrome, aggressive resection in complicated gastroschisis subjects children to prolonged dependence on parenteral nutrition and its attendant complications. Herein, we describe a novel technique aimed towards bowel preservation in complex gastroschisis patients with severe bowel ischemia with the ultimate goal for enteral autonomy.
Gastroschisis
Short Bowel Syndrome
Bowel resection
Intestinal resection
Enteral administration
Abdominal wall defect
Intestinal Ischemia
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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。
Short Bowel Syndrome
Bowel resection
Intestinal resection
Crohn disease
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Short Bowel Syndrome
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 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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Short Bowel Syndrome
Intestinal resection
Bowel resection
Large intestine
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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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