S1346 Operative and Long Term Results After Large Intestinal Resection, Leading to Short Bowel Syndrome, in a Cohort of 108 Chronic Radiation Enteritis Patients

Necrotizing enterocolitis (NEC) is an acquired severe disease of the digestive system affecting mostly premature babies, possibly fatal and frequently associated to systemic complications. Because of the severity of this condition and the possible long-term consequences on the child’s development, many studies have aimed at preventing the occurrence of the primary events at the level of the bowel wall (ischemia and necrosis followed by sepsis) by modifying or manipulating the diet (breast milk versus formula) and/or the feeding pattern (time for initiation after birth, continuous versus bolus feeding, modulation of intake according clinical events). Feeding have been investigated so far in order to prevent NEC. However, currently well-established and shared clinical nutritional practices are not available in preventing NEC. Nutritional and surgical treatments of NEC are instead well defined. In selected cases surgery is a therapeutic option of NEC, requiring sometimes partial intestinal resection responsible for short bowel syndrome. In this paper we will investigate the available options for treating NEC according to the Walsh and Kliegman classification, focusing on feeding practices in managing short bowel syndrome that can complicate NEC. We will also analyze the proposed ways of preventing NEC.

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Long-term outcome after extensive intestinal resection for chronic radiation enteritis

Digestive and Liver Disease ◽

10.1016/j.dld.2012.10.003 ◽

2013 ◽

Vol 45 (2) ◽

pp. 110-114 ◽

Cited By ~ 10

Author(s):

Aurelien Amiot ◽

Francisca Joly ◽

Jérémie H. Lefevre ◽

Olivier Corcos ◽

Frederic Bretagnol ◽

...

Keyword(s):

Intestinal Resection ◽

Radiation Enteritis ◽

Term Outcome ◽

Long Term Outcome ◽

Chronic Radiation

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Correction to ‘Operative and long term results after surgery for chronic radiation enteritis’ [Am J Surg 2001;182:237–242]

The American Journal of Surgery ◽

10.1016/s0002-9610(02)00816-4 ◽

2001 ◽

Vol 182 (6) ◽

pp. 752

Keyword(s):

Long Term Results ◽

Radiation Enteritis ◽

Chronic Radiation

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Biodistribution of the radiophamarceutical sodium pertechnetate (Na99mTcO4) after massive small bowel resection in rats

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502007000600003 ◽

2007 ◽

Vol 22 (6) ◽

pp. 430-435 ◽

Cited By ~ 13

Author(s):

Dâmaso de Araújo Chacon ◽

Irami Araújo-Filho ◽

Arthur Villarim-Neto ◽

Amália Cínthia Meneses Rêgo ◽

Ítalo Medeiros Azevedo ◽

...

Keyword(s):

Small Intestine ◽

Short Bowel Syndrome ◽

Intestinal Mucosa ◽

Intestinal Resection ◽

Small Bowel Resection ◽

Control Group ◽

Short Bowel ◽

Massive Resection ◽

Mucosal Thickness ◽

Misleading Interpretation

PURPOSE: To evaluate the biodistribution of sodium pertecnetate (Na99mTcO4) in organs and tissues, the morphometry of remnant intestinal mucosa and ponderal evolution in rats subjected to massive resection of the small intestine. METHODS: Twenty-one Wistar rats were randomly divided into three groups of 7 animals each. The short bowel (SB) group was subjected to massive resection of the small intestine; the control group (C) rats were not operated on, and soft intestinal handling was performed in sham rats. The animals were weighed weekly. On the 30th postoperative day, 0.l mL of Na99mTcO4, with mean activity of 0.66 MBq was injected intravenously into the orbital plexus. After 30 minutes, the rats were killed with an overdose of anesthetic, and fragments of the liver, spleen, pancreas, stomach, duodenum, small intestine, thyroid, lung, heart, kidney, bladder, muscle, femur and brain were harvested. The biopsies were washed with 0.9% NaCl.,The radioactivity was counted using Gama Counter WizardTM 1470, PerkinElmer. The percentage of radioactivity per gram of tissue (%ATI/g) was calculated. Biopsies of the remaining jejunum were analysed by HE staining to obtain mucosal thickness. Analysis of variance (ANOVA) and the Tukey test for multiple comparisons were used, considering p<0.05 as significant. RESULTS: There were no significant differences in %ATI/g of the Na99mTcO4 in the organs of the groups studied (p>0.05). An increase in the weight of the SB rats was observed after the second postoperative week. The jejunal mucosal thickness of the SB rats was significantly greater than that of C and sham rats (p<0.05). CONCLUSION: In rats with experimentally-produced short bowel syndrome, an adaptive response by the intestinal mucosa reduced weight loss. The biodistribution of Na99mTcO4 was not affected by massive intestinal resection, suggesting that short bowel syndrome is not the cause of misleading interpretation, if an examination using this radiopharmaceutical is indicated.

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Long-Term Outcome of Children with Short Bowel Syndrome Treated with a Modification of the STEP Technique Avoiding Mesenteric Defect

European Journal of Pediatric Surgery ◽

10.1055/s-0041-1735163 ◽

2021 ◽

Author(s):

Javier Bueno ◽

Laura García-Martínez ◽

Susana Redecillas ◽

Oscar Segarra ◽

Manuel López

Keyword(s):

Short Bowel Syndrome ◽

Bacterial Overgrowth ◽

Central Line ◽

Term Outcome ◽

Long Term Outcome ◽

Short Bowel ◽

Mesenteric Defects ◽

Multiple Ulcers

Abstract Background The Serial Transverse Enteroplasty Procedure (STEP) Registry has reported a 47% success to achieve enteral autonomy in pediatric short bowel syndrome (SBS). We have performed the STEP with a technical modification (MSTEP) consisting in stapler application without mesenteric defects that can also be applied to the duodenum. Our experience with this technique is described. Materials and Methods In this study, 16 children with SBS underwent MSTEP (2005–2019). Indications were nutritional autonomy achievement (n = 11, with duodenal lengthening in 5/11) and bacterial overgrowth treatment (n = 5). Results With a median follow-up of 5.8 years (0.7–13.7 years), 5 of 11 (45%) patients achieved enteral autonomy, 4 of them with duodenal lengthening. Four of four who preserved > 50% colon, while only one of seven with < 50% of colon achieved enteral autonomy (p < 0.05). After redo procedures, three of four attained enteral autonomy. Thus, 8 of 11 (73%) progressed to enteral autonomy, including all with duodenal lengthening. One child, already parenteral nutrition free, died due to central line sepsis. All the patients from the bacterial translocation group improved their metabolic/nutritional status, but one required subsequent enterectomy of the lengthened intestine due to multiple ulcers in the staple lines. Conclusion The effectiveness of MSTEP to achieve enteral autonomy seems similar to the classical STEP. It can be applied to the duodenum. The retained colon length may influence the post-STEP enteral autonomy achievement.

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