Remaining Small Bowel Length Can Predict the High Rate of Total Parenteral Nutrition Complications in Intestinal Failure?

The diagnostic features of copper deficiency are discussed, and a case presentation is compared with other reports in the literature. The need for copper supplement is stressed when total parenteral nutrition (TPN) is given to patients whose gastrointestinal tract is either shortened or incapable of reabsorbing copper. Since copper is recycled through the small bowel by way of the bile, any dysfunction of this area can lead to copper deficiency during TPN if inadequate amounts of copper are added to the basic TPN solutions. It is suggested that Dr. Shils' formula be used twice weekly for prophylaxis during long-term hyperalimentation and daily as a therapeutic agent when a deficiency is diagnosed.

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In Vivo Small Bowel Length is Longer than in Formalin-Fixed Cadavers

International Journal of Surgery Research & Practice ◽

10.23937/2378-3397/1410107 ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Zhou Randal ◽

Orkin Bruce A ◽

Williams James M ◽

Serici Anthony ◽

Poirier Jennifer ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Length ◽

Bowel Length ◽

Formalin Fixed

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Intraoperative small bowel length measurements and analysis of demographic predictors of increased length

Clinical Anatomy ◽

10.1002/ca.22238 ◽

2013 ◽

pp. n/a-n/a ◽

Cited By ~ 5

Author(s):

Ezra N. Teitelbaum ◽

Khashayar Vaziri ◽

Sara Zettervall ◽

Richard L. Amdur ◽

Bruce A. Orkin

Keyword(s):

Small Bowel ◽

Small Bowel Length ◽

Bowel Length ◽

Demographic Predictors ◽

Length Measurements

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Preliminary Experience With Intestinal Transplantation in Infants and Children

PEDIATRICS ◽

10.1542/peds.97.4.443 ◽

1996 ◽

Vol 97 (4) ◽

pp. 443-448

Author(s):

Alan N. Langnas ◽

B. W. Shaw ◽

Dean L. Antonson ◽

Stuart S. Kaufman ◽

David R. Mack ◽

...

Keyword(s):

Small Bowel ◽

Parenteral Nutrition ◽

Total Parenteral Nutrition ◽

Short Bowel Syndrome ◽

Gastrointestinal Disease ◽

Intestinal Transplantation ◽

Infants And Children ◽

Short Bowel ◽

In Infants And Children

Objective. This report discusses the preliminary experience with intestinal transplantation in children at the University of Nebraska Medical Center. Patients. During the past 4 years, 16 intestinal transplants have been performed in infants and children. Thirteen have been combined liver and bowel transplants, and the remainder were isolated intestinal transplants. Nearly half of the patients were younger than 1 year of age at the time of surgery, and the vast majority were younger than 5 years of age. All but one had short bowel syndrome. Results. The 1-year actuarial patient and graft survival rates for recipients of liver and small bowel transplants were 76% and 61%, respectively. Eight of 13 patients who received liver and small bowel transplants remain alive at the time of this writing, with a mean length of follow-up of 263 (range, 7 to 1223) days. Six patients are currently free of total parenteral nutrition. All three patients receiving isolated intestinal transplants are alive and free of parenteral nutrition. The mean length of follow-up is 384 (range, 330 to 450) days. Major complications have included severe infections and rejection. Lymphoproliferative disease, graft-versus-host disease, and chylous ascites have not been major problems. Conclusions. Although intestinal transplantation is in its infancy, these preliminary results suggest combined liver and bowel transplants and isolated intestinal transplantation may be viable options for some patients with intestinal failure caused by short bowel syndrome or other gastrointestinal disease in whom long-term total parenteral nutrition is not an attractive option.

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Causes and Prognosis of Intestinal Failure in Crohn’s Disease: An 18-year Experience From a National Centre

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa060 ◽

2020 ◽

Vol 14 (11) ◽

pp. 1558-1564 ◽

Cited By ~ 1

Author(s):

Mattias Soop ◽

Haroon Khan ◽

Emma Nixon ◽

Antje Teubner ◽

Arun Abraham ◽

...

Keyword(s):

Risk Factors ◽

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Abdominal Surgery ◽

Parenteral Nutrition ◽

Intestinal Failure ◽

Anastomotic Dehiscence ◽

Septic Complication ◽

Kaplan Meier

Abstract Background and Aims Intestinal failure [IF] is a feared complication of Crohn’s disease [CD]. Although cumulative loss of small bowel due to bowel resections is thought to be the dominant cause, the causes and outcomes have not been reported. Methods Consecutive adult patients referred to a national intestinal failure unit over 2000–2018 with a diagnosis of CD, and subsequently treated with parenteral nutrition during at least 12 months, were included in this longitudinal cohort study. Data were extracted from a prospective institutional clinical database and patient records. Results A total of 121 patients were included. Of these, 62 [51%] of patients developed IF as a consequence of abdominal sepsis complicating abdominal surgery; small bowel resection, primary disease activity, and proximal stoma were less common causes [31%, 12%, and 6%, respectively]. Further, 32 had perianastomotic sepsis, and 15 of those had documented risk factors for anastomotic dehiscence. On Kaplan-Meier analysis, 40% of all patients regained nutritional autonomy within 10 years and none did subsequently; 14% of patients developed intestinal failure-associated liver disease. On Kaplan-Meier analysis, projected mean age of death was 74 years.2 Conclusions IF is a severe complication of CD, with 60% of patients permanently dependent on parenteral nutrition. The most frequent event leading directly to IF was a septic complication following abdominal surgery, in many cases following intestinal anastomosis in the presence of significant risk factors for anastomotic dehiscence. A reduced need for abdominal surgery, an increased awareness of perioperative risk factors, and structured pre-operative optimisation may reduce the incidence of IF in CD.

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Life without Eating or Drinking

Canadian Psychiatric Association Journal ◽

10.1177/070674377802300604 ◽

1978 ◽

Vol 23 (6) ◽

pp. 373-379 ◽

Cited By ~ 25

Author(s):

K.J. Macritchie

Keyword(s):

Small Bowel ◽

Parenteral Nutrition ◽

Total Parenteral Nutrition ◽

Bowel Function ◽

Psychological Trauma ◽

Psychological Disturbance ◽

Environmental Support ◽

Psychosocial Studies ◽

The Individual ◽

Small Bowel Function

Total Parenteral Nutrition is no longer a short-term life-saving therapy, but can now provide an alternative permanent nutritional route following loss of small bowel function. Patients placed on the regimen go through several stages during adaptation. Those who have suffered from a chronic debilitating small bowel disease and have previously undergone multiple resections with poor residual nutritional intake, adapt more readily to the regimen than those who have suffered from the combined physical and psychological trauma of sudden massive loss of bowel. The technique has been successful in maintaining one individual in the group studied in good nutritional balance outside hospital for a period of eight years (13). This has been due to combined advances in medical surgical and pharmaceutical techniques (8). Further refinement of the nutritional support system utilized is needed to reduce the duration of the feeding process with the aim of minimizing sleep interruption and resultant fatigue. In elective consideration for TPN, assessment of both personality structure and domestic environmental support is advisable, since the patient generally does not do well in an unsupportive environment with resultant complications and frequent re-hospitalization. Conjoint training of a spouse or family member is essential; and introduction to another patient who has previously adapted well is beneficial. Later, a close liaison should be established with a Home Alimentation Nurse (8-10). The psychiatrist has a potential role in advising the gastroenterologist regarding the suitability of the individual being considered for elective total parenteral nutrition. He has a more definite role in the management of the psychological disturbance, frequently observed as depression, following surgery or later, when it appears secondary to the problems imposed by an altered modus vivendi. The group poses a further special challenge to the psychiatrist due to the unavailability of the normal route of administration of psychotropic drugs when they are indicated. In addition to the attainment of a relatively normal survival of individuals who have sustained complete loss of small bowel function, TPN offers vistas for research into body nutrition requirements (11) and demands further extensive detailed psychosocial studies of this unique group of individuals.

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