Autologous Gastrointestinal Reconstruction (AGR) for Patients with Enterocutaneous Fistula - associated intestinal failure

2017 ◽  
Vol 101 ◽  
pp. S49
Author(s):  
Ruy J. Cruz ◽  
Jenee McGurgan ◽  
William Stein ◽  
Laurie Butera ◽  
Armando Ganoza ◽  
...  
Keyword(s):  
Enterocutaneous Fistula ◽  
Intestinal Failure ◽  
Gastrointestinal Reconstruction

scholarly journals Short bowel syndrome in infancy: recent advances and practical management

2020 ◽  
pp. flgastro-2020-101457
Author(s):  
Elena Cernat ◽  
Chloe Corlett ◽  
Natalia Iglesias ◽  
Nkem Onyeador ◽  
Julie Steele ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Intestinal Adaptation ◽  
Intestinal Failure ◽  
Rare Condition ◽  
Oral Feeding ◽  
Short Bowel ◽  
Intestinal Continuity ◽  
Gastrointestinal Reconstruction ◽  
Lipid Reduction

Short bowel syndrome (SBS) is a rare condition characterised by extensive loss of intestinal mass secondary to congenital or acquired disease. The outcomes are determined by dependency on parenteral nutrition (PN), its possible complications and factors that influence intestinal adaptation. In order to achieve the best results, patients should be managed by a specialised multidisciplinary team with the aims of promoting growth and development, stimulating intestinal adaptation and preventing possible complications. This involves timely surgical management aimed at rescuing maximum bowel length and eventually re-establishing intestinal continuity where appropriate. A combination of enteral and parenteral nutrition needs to be targeted towards maintaining a balance between fulfilling the nutritional and metabolic needs of the child while preventing or at least minimising potential complications. Enteral nutrition and establishment of oral feeding play a fundamental role in stimulating bowel adaptation and promoting enteral autonomy. Other measures to promote enteral autonomy include the chyme recycling in patients where bowel is not in continuity, autologous gastrointestinal reconstruction and pharmacological treatments, including promising new therapies like teduglutide. Strategies such as lipid reduction, changing the type of lipid emulsion and cycling PN are associated with a reduction in the rates of intestinal failure–associated liver disease. Even though vast improvements have been made in the surgical and medical management of SBS, there is still lack of consensus in many aspects and collaboration is essential.

Incisional hernia and enterocutaneous fistula in patients with chronic intestinal failure: prevalence and risk factors in a cohort of patients referred to a tertiary centre

2019 ◽  
Vol 21 (11) ◽  
pp. 1288-1295
Author(s):  
J. D. Hodgkinson ◽  
S. M. Oke ◽  
J. Warusavitarne ◽  
G. B. Hanna ◽  
S. M. Gabe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Incisional Hernia ◽  
Enterocutaneous Fistula ◽  
Intestinal Failure ◽  
Tertiary Centre

scholarly journals Lessons learned from successful autologous gastrointestinal reconstruction in patients with intestinal failure: a case series

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kiarash Ashrafzadeh ◽  
Mojtaba Shafiekhani ◽  
Nazanin Azadeh ◽  
Maryam Esmaeili ◽  
Hamed Nikoupour
Keyword(s):  
Intestinal Failure ◽  
Case Series ◽  
Intestinal Transplantation ◽  
Operative Management ◽  
Severe Form ◽  
Lessons Learned ◽  
Ulcer Bleeding ◽  
Fistula Formation ◽  
Complications Of Surgery ◽  
Gastrointestinal Reconstruction

Abstract Background Intestinal failure (IF) is a rare but severe form of organ failure. The condition is defined as body’s inability to absorb adequate fluids, macronutrients and minerals for growth and development, so that intravenous supplementation is necessary. A broad spectrum of diseases, trauma and complications of surgery might eventually end up with intestinal failure. Nowadays, intestinal failure patients are preferably cared for in intestinal rehabilitation units (IRU). Autologous gastrointestinal reconstruction (AGIR) refers to non-transplant operative management of IF patients designed to improve enteral tolerance and gut absorptive capacity. Case presentation Herein we present five cases with complications of surgeries due to peptic ulcer bleeding, blunt abdominal trauma, obesity and gastric tumor. The surgeries were complicated by anastomotic leak, peritonitis and fistula formation. By adopting multidisciplinary decisions and special care for each complication, all the five patients were successfully managed and discharged. Discussion and conclusions As presented, re-anastomosis in presence of abdominal contamination will probably fail. In patients with intestinal failure, PN should start as soon as possible to increase the success rate of future surgeries and prevent potential need for intestinal transplantation. We suggest referring patients with complicated outcomes of gastrointestinal surgeries to the IRUs to reduce morbidity and mortality.

scholarly journals The medical management of intestinal failure: methods to reduce the severity

2003 ◽  
Vol 62 (3) ◽  
pp. 703-710 ◽  
Author(s):  
Jeremy M. D. Nightingale
Keyword(s):  
Small Bowel ◽  
Enterocutaneous Fistula ◽  
Intestinal Failure ◽  
Bacterial Overgrowth ◽  
Oral Intake ◽  
Renal Stones ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Proximal Small Bowel ◽  
Intestinal Pseudo Obstruction

A new definition of intestinal failure is of reduced intestinal absorption so that macronutrient and/or water and electrolyte supplements are needed to maintain health or growth. Severe intestinal failure is when parenteral nutrition and/or fluid are needed and mild intestinal failure is when oral supplements or dietary modification suffice. Treatment aims to reduce the severity of intestinal failure. In the peri-operative period avoiding the administration of excessive amounts of intravenous saline (9 g NaCl/l) may prevent a prolonged ileus. Patients with intermittent bowel obstruction may be managed with a liquid or low-residue diet. Patients with a distal bowel entero-cutaneous fistula may be managed with an enteral feed absorbed by the proximal small bowel while no oral intake may be needed for a proximal bowel enterocutaneous fistula. Patients undergoing high-dose chemotherapy can usually tolerate jejunal feeding. Rotating antibiotic courses may reduce small bowel bacterial overgrowth in patients with chronic intestinal pseudo-obstruction. Restricting oral hypotonic fluids, sipping a glucose-saline solution (Na concentration of 90–120 mmol/l) and taking anti-diarrhoeal or anti-secretory drugs, reduces the high output from a jejunostomy. This treatment allows most patients with a jejunostomy and >1 m functioning jejunum remaining to manage without parenteral support. Patients with a short bowel and a colon should consume a diet high in polysaccharides, as these compounds are fermented in the colon, and low in oxalate, as 25% of the oxalate will develop as calcium oxalate renal stones. Growth factors normally produced by the colon (e.g. glucagon-like peptide-2) to induce structural jejunal adaptation have been given in high doses to patients with a jejunostomy and do marginally increase the daily energy absorption.

Considerations for the management of enterocutaneous fistula

2019 ◽  
Vol 17 (4) ◽  
pp. 36-42
Author(s):  
Christine Metcalf
Keyword(s):  
Multidisciplinary Approach ◽  
Early Recognition ◽  
Enterocutaneous Fistula ◽  
Intestinal Failure ◽  
Nutrition Support ◽  
Wound Management ◽  
Care Nurse ◽  
Electrolyte Homeostasis ◽  
Stoma Care ◽  
Experience Pain

Enterocutaneous fistula is an abnormal connection between the gastrointestinal tract and skin. Management includes early recognition and treatment of sepsis, reducing fluid and electrolyte homeostasis, nutrition support, wound management and a carefully timed surgical procedure. A multidisciplinary approach is required for successful management of these patients with one of the most challenging and resource-demanding aspects being local control of the effluent, requiring the skill and support of the specialist stoma care nurse. The inability to contain the fistula can be a source of morbidity for the patient, as they will experience pain and severe discomfort from the skin when leakages occur. Enterocutaneous fistula can result in intestinal failure, which is often fatal if not managed correctly.

scholarly journals Management of Intestinal Failure: The High-Output Enterostomy and Enterocutaneous Fistula

2017 ◽  
Vol 30 (03) ◽  
pp. 215-222 ◽  
Author(s):  
Franklin Adaba ◽  
Carolynne Vaizey ◽  
Janindra Warusavitarne
Keyword(s):  
Multidisciplinary Approach ◽  
Enterocutaneous Fistula ◽  
Intestinal Failure ◽  
Successful Management ◽  
Fluid Losses ◽  
High Output

AbstractThis article provides an overview of the pathophysiology, causes, investigations, and management of high-output enterostomy and enterocutaneous fistula. High-output stoma and enterocutaneous fistula can result in intestinal failure and this is often fatal if not managed properly. The management involves reducing fluid losses, providing nutrients with fluids, and treating the underlying cause and sepsis. A multidisciplinary approach is required for successful management of patients with high-output enterostomy and enterocutaneous fistula.

The importance of a holistic approach to stoma care: A case review

WCET Journal ◽  
2019 ◽  
pp. 23-32
Author(s):  
Melanie C Perez
Keyword(s):  
Ileal Conduit ◽  
Enterocutaneous Fistula ◽  
Foley Catheter ◽  
Holistic Approach ◽  
Comprehensive Care ◽  
Case Review ◽  
High Output ◽  
Stoma Care

This case review discusses the importance of providing a holistic approach to the care of a patient with two stomas and an enterocutaneous fistula. In this case, the stomas and fistula significantly affected the patient; not just physically but emotionally and socially. The different challenges that arose in pouching a high-output ileostomy, enterocutaneous fistula and ileal conduit with Foley catheter in situ are explored. It also delves into the various options for discharging a patient with complex ostomy complications requiring different needs and resources. Finally, it aims to highlight the therapeutic comprehensive care the stomal therapy nurse provided to the patient and their family.

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