Corneal perforation due to vitamin A deficiency in a patient with short bowel syndrome

2021 ◽  
Vol 14 (9) ◽  
pp. e242776
Author(s):  
Hannah Fieldhouse ◽  
Achim Nestel ◽  
Byron Theron ◽  
Nathaniel Knox Cartwright
Keyword(s):  
Small Bowel ◽  
Vitamin A ◽  
Short Bowel Syndrome ◽  
Vitamin A Deficiency ◽  
Small Bowel Resection ◽  
Caucasian Woman ◽  
Corneal Perforation ◽  
Blurred Vision ◽  
Short Bowel ◽  
Bowel Surgery

A 55-year-old Caucasian woman presented with a 1-week history of left eye redness and blurred vision. Her medical history included previous small bowel resection and ileostomy for ischaemic bowel. Ophthalmic examination revealed a left corneal ulcer requiring hospital admission for intensive topical antibiotics. Overnight she became systemically unwell and was diagnosed with urinary tract infection requiring intravenous antibiotics. Her corneal condition deteriorated resulting in corneal perforation, which required a surgical gluing procedure. Despite surgery, the cornea perforated on two further occasions. At this stage, vitamin A deficiency (VAD) was suspected, due to the corneal melting response that was occurring. VAD was subsequently confirmed by serology and had occurred in this case due to malabsorption as a result of short bowel syndrome caused by previous small bowel surgery. The patient was treated with intramuscular vitamin A and eventually made a good visual and systemic recovery.

Pediatric Short Bowel Syndrome: Predicting Four-Year Outcome after Massive Neonatal Resection

2017 ◽  
Vol 28 (05) ◽  
pp. 455-463 ◽  
Author(s):  
Teresa Capriati ◽  
Daniela Giorgio ◽  
Fabio Fusaro ◽  
Manila Candusso ◽  
Paolo Schingo ◽  
...  
Keyword(s):  
Small Bowel ◽  
Short Bowel Syndrome ◽  
Intestinal Adaptation ◽  
Bloodstream Infections ◽  
Small Bowel Resection ◽  
Strongly Correlated ◽  
Small Bowel Length ◽  
Short Bowel ◽  
Intestinal Length ◽  
End Stage

Objectives The aim of this study was to ascertain predictors of survival, liver disease (LD), and enteral autonomy 48 months after resection in neonatal short bowel syndrome (SBS) patients with residual small bowel length (SBL) ≤40 cm. Patients and Methods Medical records of all SBS patients followed up between 1996 and 2016 were retrospectively reviewed. Survival rate, prevalence of LD, and of enteral autonomy were evaluated. Results Forty-seven patients were included, and 43 were still alive at the end of the study period, with cumulative 48-month survival of 91.5%. Twenty-one (45%) patients developed LD, all within the first 6 months. On the final follow-up visit, three (6%) patients were still jaundiced and progressed toward end-stage LD. LD prevalence was higher in patients with recurrent bloodstream infections (odds ratio [OR] 5.4, 95% confidence interval [CI] 1.5–19.3). Of the 43 surviving patients, 22 (51%) had enteral autonomy 48 months after resection. The probability of weaning off parenteral nutrition (PN) was strongly correlated with the remaining SBL. Conclusion Survival of patients who have undergone neonatal massive small bowel resection has improved in recent years. Multidisciplinary strategies can improve the course of LD, but not the probability of weaning off PN, which seems to be strongly dependent on the anatomical profile of residual bowel. Therefore, the primary surgical approach should be as conservative as possible to gain even small amounts of intestinal length, which may be crucial in promoting intestinal adaptation.

Stimulation of intestinal growth and function with DPP4 inhibition in a mouse short bowel syndrome model

2014 ◽  
Vol 307 (4) ◽  
pp. G410-G419 ◽  
Author(s):  
Ryo Sueyoshi ◽  
Kathleen M. Woods Ignatoski ◽  
Manabu Okawada ◽  
Bolette Hartmann ◽  
Jens Holst ◽  
...  
Keyword(s):  
Small Bowel ◽  
Short Bowel Syndrome ◽  
Plasma Levels ◽  
Bowel Resection ◽  
Small Bowel Resection ◽  
Nuclear Antigen ◽  
Intestinal Growth ◽  
Short Bowel ◽  
Time Points ◽  
Absorptive Function

Glucagon-like peptide-2 (GLP-2) has been shown to be effective in patients with short bowel syndrome (SBS), but it is rapidly inactivated by dipeptidyl peptidase IV (DPP4). We used an orally active DPP4 inhibitor (DPP4-I), MK-0626, to determine the efficacy of this approach to promote adaptation after SBS, determined optimal dosing, and identified further functional actions in a mouse model of SBS. Ten-week-old mice underwent a 50% proximal small bowel resection. Dose optimization was determined over a 3-day post-small bowel resection period. The established optimal dose was given for 7, 30, and 90 days and for 7 days followed by a 23-day washout period. Adaptive response was assessed by morphology, intestinal epithelial cell (IEC) proliferation (proliferating cell nuclear antigen), epithelial barrier function (transepithelial resistance), RT-PCR for intestinal transport proteins and GLP-2 receptor, IGF type 1 receptor, and GLP-2 plasma levels. Glucose-stimulated sodium transport was assessed for intestinal absorptive function. Seven days of DPP4-I treatment facilitated an increase in GLP-2 receptor levels, intestinal growth, and IEC proliferation. Treatment led to differential effects over time, with greater absorptive function at early time points and enhanced proliferation at later time points. Interestingly, adaptation continued in the group treated for 7 days followed by a 23-day washout. DPP4-I enhanced IEC proliferative action up to 90 days postresection, but this action seemed to peak by 30 days, as did GLP-2 plasma levels. Thus DPP4-I treatment may prove to be a viable option for accelerating intestinal adaptation with SBS.

Short- and long-term effects of small bowel resection: a unique histological study in a piglet model of short bowel syndrome

2011 ◽  
Vol 135 (2) ◽  
pp. 195-202 ◽  
Author(s):  
Prue M. Pereira-Fantini ◽  
Sarah L. Thomas ◽  
Guineva Wilson ◽  
Russell G. Taylor ◽  
Magdy Sourial ◽  
...  
Keyword(s):  
Small Bowel ◽  
Short Bowel Syndrome ◽  
Bowel Resection ◽  
Histological Study ◽  
Small Bowel Resection ◽  
Long Term Effects ◽  
Short Bowel ◽  
Short And Long Term

scholarly journals Hypomagnesemia in short bowel syndrome patients

2000 ◽  
Vol 118 (6) ◽  
pp. 169-172 ◽  
Author(s):  
Simone Chaves Miranda ◽  
Michelle Lizzy Bandeira Ribeiro ◽  
Eduardo Ferriolli ◽  
Júlio Sérgio Marchini
Keyword(s):  
Small Bowel ◽  
Short Bowel Syndrome ◽  
Bowel Resection ◽  
Serum Magnesium ◽  
Small Bowel Resection ◽  
University Hospital ◽  
Short Bowel ◽  
Metabolic Unit ◽  
The University

CONTEXT: Magnesium support to small bowel resection patients. OBJECTIVE: Incidence and treatment of hypomagnesemia in patients with extensive small bowel resection. DESIGN: Retrospective study. SETTING: Metabolic Unit of the University Hospital Medical School of Ribeirão Preto, University of São Paulo, Brazil. PATIENTS: Fifteen patients with extensive small bowel resection who developed short bowel syndrome. MAIN MEASUREMENTS: Serum magnesium control of patients with bowel resection. Replacement of magnesium when low values were found. RESULTS: Initial serum magnesium values were obtained 21 to 180 days after surgery. Hypomagnesemia [serum magnesium below 1.5 mEq/l (SD 0.43)] was detected in 40% of the patients [1,19 mEq/l (SD 0.22)]. During the follow-up period, 66% of the patients presented at least two values below reference (1.50 mEq/l). 40% increased their serum values after magnesium therapy. CONCLUSION: Metabolic control of serum magnesium should be followed up after extensive small bowel resection. Hypomagnesemia may be found and should be controlled.

Pediatric Short Bowel Syndrome: Adaptation After Massive Small Bowel Resection

2007 ◽  
Vol 45 (2) ◽  
pp. 213-221 ◽  
Author(s):  
Ljubomir Rossi ◽  
Padmalatha Kadamba ◽  
Claes Hugosson ◽  
Edward B De Vol ◽  
Zakaria Habib ◽  
...  
Keyword(s):  
Small Bowel ◽  
Short Bowel Syndrome ◽  
Bowel Resection ◽  
Small Bowel Resection ◽  
Short Bowel ◽  
Massive Small Bowel Resection

scholarly journals Tis7 deletion reduces survival and induces intestinal anastomotic inflammation and obstruction in high-fat diet-fed mice with short bowel syndrome

2014 ◽  
Vol 307 (6) ◽  
pp. G642-G654 ◽  
Author(s):  
Amy M. Garcia ◽  
Derek Wakeman ◽  
Jianyun Lu ◽  
Christopher Rowley ◽  
Taylor Geisman ◽  
...  
Keyword(s):  
Lipid Metabolism ◽  
Small Bowel ◽  
Short Bowel Syndrome ◽  
High Fat Diet ◽  
Adaptive Response ◽  
Bowel Resection ◽  
Control Diet ◽  
Small Bowel Resection ◽  
High Fat ◽  
Short Bowel

Effective therapies are limited for patients with parenteral nutrition-dependent short bowel syndrome. We previously showed that intestinal expression of the transcriptional coregulator tetradecanoyl phorbol acetate-induced sequence 7 ( tis7) is markedly increased during the adaptive response following massive small bowel resection and tis7 plays a role in normal gut lipid metabolism. Here, we further explore the functional implications of tis7 deletion in intestinal lipid metabolism and the adaptive response following small bowel resection. Intestinal tis7 transgenic ( tis7tg), tis7−/−, and wild-type (WT) littermates were subjected to 50% small bowel resection. Mice were fed a control or a high-saturated-fat (42% energy) diet for 21 days. Survival, body weight recovery, lipid absorption, mucosal lipid analysis, and the morphometric adaptive response were analyzed. Quantitative real-time PCR was performed to identify tis7 downstream gene targets. Postresection survival was markedly reduced in high-fat, but not control, diet-fed tis7−/− mice. Decreased survival was associated with anastomotic inflammation and intestinal obstruction postresection. High-fat, but not control, diet-fed tis7−/− mice had increased intestinal IL-6 expression. Intestinal lipid trafficking was altered in tis7−/− compared with WT mice postresection. In contrast, high-fat diet-fed tis7tg mice had improved survival postresection compared with WT littermates. High-fat diet feeding in the setting of tis7 deletion resulted in postresection anastomotic inflammation and small bowel obstruction. Tolerance of a calorie-rich, high-fat diet postresection may require tis7 and its target genes. The presence of luminal fat in the setting of tis7 deletion promotes an intestinal inflammatory response postresection.

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