scholarly journals Serial transverse enteroplasty and nipple valve construction, two life saving techniques for patients with short bowel syndrome, a report of 5 cases

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mojtaba Shafiekhani ◽  
Nazanin Azadeh ◽  
Kiarash Ashrafzadeh ◽  
Maryam Esmaeili ◽  
Hamed Nikoupour
Keyword(s):  
Small Intestine ◽  
Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Intestinal Adaptation ◽  
Ileocecal Valve ◽  
Intestinal Transit Time ◽  
Short Bowel ◽  
Nipple Valve ◽  
Gastrointestinal Reconstruction ◽  
Serial Transverse Enteroplasty

Abstract Background Various abdominal pathologies end up with surgical resection of small intestine. When the small intestine remnant is too short for adequate fluid and micronutrients absorption, short bowel syndrome is diagnosed. The disabling condition needs a multidisciplinary approach to design parenteral nutrition, care for thrombotic, hepatic and infectious complications and gradually wean the patient from parenteral nutrition. Various surgical techniques have been introduced to increase absorptive mucosa and enhance the intestinal adaptation process. Serial transverse enteroplasty and nipple valve reconstruction are among the procedures, which will be discussed in the current article. Case presentation Herein, we presented 5 cases of short bowel syndrome as a consequence of abdominal laparotomies, patients were referred to our center to receive parenteral nutrition and to be prepared for the final autologous gastrointestinal reconstruction or intestinal transplantation, if indicated. Conclusion Patient’s age, performance status and bowel remnant length determines the appropriate technique for autologous gastrointestinal reconstruction. Serial transverse enteroplasty is designed to increase bowel’s length by creating zigzag patterns through dilated bowel loops. Presence of ileocecal valve is crucial to delay intestinal transit time and to prevent colonic bacterial transfer to ileum. Patient’s with ileocecal valve loss benefit from creating an artificial valve, namely, nipple valve.

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.

scholarly journals Short Bowel Syndrome: Intestinal Adaptation and Medical Therapy

1990 ◽  
Vol 4 (2) ◽  
pp. 70-78
Author(s):  
WD Buie ◽  
OG Thurston ◽  
Richard N Fedorak
Keyword(s):  
Surface Area ◽  
Short Bowel Syndrome ◽  
Intestinal Adaptation ◽  
Ileocecal Valve ◽  
Significant Loss ◽  
Intestinal Transit Time ◽  
Short Bowel ◽  
Early Use ◽  
Adaptive Ability ◽  
Mucosal Surface Area

Short bowel syndrome is a clinical entity, a consequence of significant loss of intestinal surface area, and manifests a variable picture of diarrhea, steatorrhea, malabsorprion and weight loss. Previously high mortality rates have been reduced by the early use of parenteral nutrition and have subsequently resulted in increased survival and prevalence of the condition. Ultimate patient survival is dependent on the intrinsic adaptive ability of residual intestine and this, in turn, is dependent upon length, type, functional state and the presence or absence of an ileocecal valve. The mechanisms of intestinal adaptation are not entirely understood; however, they can be grouped into three broad categories: luminal nutrition, hormonal factors, and pancreaticobiliary secretion. Medical treatment of short bowel syndrome remains supportive and centres around the control of three pathophysiological defects: decreased intestinal transit time, gastric hypersecretion, and reduced functional mucosal surface area.

scholarly journals Long-Term Results of Serial Transverse Enteroplasty with Neovalve Creation for Extreme Short Bowel Syndrome: Report of Two Cases

2017 ◽  
Vol 11 (1) ◽  
pp. 229-240 ◽  
Author(s):  
Mireia Botey ◽  
Antonio Alastrué ◽  
Henrik Haetta ◽  
Jaume Fernández-Llamazares ◽  
Arantxa Clavell ◽  
...  
Keyword(s):  
Short Bowel Syndrome ◽  
Intestinal Adaptation ◽  
Treatment Algorithm ◽  
Surgical Techniques ◽  
Ileocecal Valve ◽  
Long Term Results ◽  
Minimum Length ◽  
Short Bowel ◽  
First Case ◽  
Serial Transverse Enteroplasty

Objective: The aim of this article was to determine whether serial transverse enteroplasty (STEP) and the creation of a new ileocecal valve in extreme short bowel syndrome (SBS) cases (<45 cm) is effective in intestinal adaptation and improvement of nutritional parameters and serum citrulline levels. Patients and Methods: We present 2 cases of SBS treated with STEP. Enterectomy was performed for massive intestinal ischemia secondary to a gastrointestinal stromal tumor in the first case and to catastrophic antiphospholipid syndrome in the second. After enterectomy, the short residual bowel measured 34 cm in the first patient and 45 cm in the second. In both cases STEP, cholecystectomy, and gastrostomy were performed. In the first case a Brooke neovalve was created, and in the other the ileocecal valve was preserved. Results: Both patients could finally be weaned off total parenteral nutrition (TPN) and gastrostomy feeding, maintaining a good nutritional status 1 year after surgery. Conclusions: In extreme SBS, a minimum length of 80–90 cm of functioning small bowel and an intact ileocecal valve are necessary. We plead for the use of STEP with preservation of the ileocecal valve or creation of a neovalve using the Brooke technique in order to achieve the ultimate goal, which is to wean patients off TPN. After a critical review of different surgical techniques, a treatment algorithm is proposed.

scholarly journals Experiencia con el uso de teduglutide en pacientes pediátricos con fallo intestinal en un centro de Argentina

2020 ◽  
Author(s):  
María Inés Martínez ◽  
Carolina Rumbo ◽  
Dolores García Hervás ◽  
Julio Trentadue ◽  
Gabriel Gondolesi ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Treatment Time ◽  
Intestinal Adaptation ◽  
Ileocecal Valve ◽  
The United States ◽  
Synthetic Analogue ◽  
Older Children ◽  
Short Bowel ◽  
A Prospective Study

Introduction. Teduglutide is a synthetic analogue of the glucagon-like peptide type 2, recently approved in Europe and in the United States for paediatric use, to promote intestinal adaptation in short bowel syndrome cases. The experience in children is limited. Objective. The aim of this work is to present the evolution of the first paediatric series treated with teduglutide in Argentina. Material and methods. A prospective study was realized on patient records under 18 years treated in a rehabilitation and intestine transplant unit since 2017. Of 62 children with short bowel syndrome, 5 received teduglutide 0.05 mg/kg/subcutaneous day. Diagnostics, type of anatomy and evolution of parenteral nutrition requirements were realized . Results. Etiology of short bowel syndrome: 3 congenital malformations: 2 atresias, 1 gastroschisis, two causes in older children: 1 volvulus and 1 abdominal trauma. Anatomy. Three patients type 2A, one type 2B and one type 3A, the length of the remaining intestine (mean and DS) 25.7 ± 19 cm, 1 with ileocecal valve and colon, 4 left hemicolon. The age at the beginning of parenteral nutrition was 6.2 ± 0.4 years, time on previous parenteral nutrition was 7.1 ± 4 years. The treatment time with teduglutide was 52.2 ± 39 weeks. The parenteral nutrition requirements were reduced by 56 ± 48%, in all patients, and could be suspended in 2 (at the 29th and 24th weeks of treatment). There was no deterioration of the z score of BMI/age (initial 0.16 ± 0.3 vs. 0.14 ± 1.02), nor of the height/age (-2.01 ± 1.5 vs. -1.76 ± 1.42). Conclusion. It was concluded that the use of teduglutide as a therapeutic alternative in the short bowel syndrome in paediatrics was effective and safe in this group of patients, allowing the restoration of intestinal sufficiency or reducing the requirements of parenteral nutrition.

scholarly journals Clinical case and short review of extreme short bowel syndrome: an update 21 years after

2016 ◽  
Vol 10 (1) ◽  
pp. 45
Author(s):  
Pasquale Mansueto ◽  
Aurelio Seidita ◽  
Salvatore Iacono ◽  
Antonio Carroccio
Keyword(s):  
Small Intestine ◽  
Short Bowel Syndrome ◽  
Clinical Case ◽  
Ileocecal Valve ◽  
Short Review ◽  
Short Bowel ◽  
Massive Resection ◽  
Low Weight ◽  
Clinical Conditions

Short bowel syndrome refers to the malabsorptive state caused by loss of significant portions of the small intestine, whose clinical framework is characterized by malnutrition, diarrhea, dehydration, weight loss, and low-weight-related symptoms/signs. These clinical conditions seem to be related to the length of resection. Twenty-one years ago we reported the clinical case of an infant, who underwent a massive resection of the loops of the small intestine, of the cecum and of part of the ascending colon, due to intestinal malrotation with volvulus. The residual small intestine measured just 11 cm and consisted of the duodenum and a small part of jejunum, in the absence of the ileocecal valve, configuring the case of a <em>ultra-short bowel syndrome</em>. In this report, we update the case, reporting the patient succeeded to obtain a good weight gain and to conduct a quite normal lifestyle, despite the long-term consequences of such resection.

scholarly journals RARE CASE OF SHORT BOWEL SYNDROME

2019 ◽  
Vol 49 ◽  
pp. 6-8
Author(s):  
Azmaiparashvili G. აზმაიფარაშვილი გ. ◽  
Tomadze G. თომაძე გ. ◽  
Megreladze A. მეგრელაძე ა.
Keyword(s):  
Small Intestine ◽  
Small Bowel ◽  
Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Rare Case ◽  
Postoperative Management ◽  
Hepatic Flexure ◽  
Postoperative Treatment ◽  
Extensive Resection ◽  
Short Bowel

Short bowel syndrome is characterized by malabsorption following extensive resection of the small bowel. It may occur after resection of more than 50% and is certain after resection of more than 70% of the small intestine, or if less than 100 cm of small bowel remains.  Successful postoperative management of short bowel syndrome has been discussed. Patient was operated because of cancer of hepatic flexure of large bowel with invasion in stomach, pancreas, retroperitoneal space, mesentery of small bowel. Right sided colectomy and excessive resection of small bowel with limphodissection was performed and only 80 cm of small bowel was left together with the left part of the colon. Ileotransversoanastomosis was performed. After the adequate course of chemotherapy and partial parenteral nutrition patient’s general condition became satisfactory. Patient started to gain weight. Adequate postoperative treatment determined postoperative period without surgical and nutritional complication.

scholarly journals Congenital Short Bowel Syndrome: A Case Report and Review of the Literature

2008 ◽  
Vol 22 (1) ◽  
pp. 71-74 ◽  
Author(s):  
Mohammed Hasosah ◽  
Daniel A Lemberg ◽  
Eric Skarsgard ◽  
Richard Schreiber
Keyword(s):  
Small Bowel ◽  
Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Intestinal Adaptation ◽  
Rare Condition ◽  
Normal Growth ◽  
Upper Gastrointestinal Endoscopy ◽  
Term Survival ◽  
Short Bowel ◽  
Upper Gastrointestinal

Congenital short bowel syndrome (SBS) is a rare condition of the newborn, with several reports demonstrating high mortality. A six-week-old boy presented with chronic diarrhea and failure to thrive. An upper gastrointestinal endoscopy showed a straight duodenum, and multiple small bowel biopsies were histologically normal. An upper gastrointestinal series showed malrotation. At laparotomy, the small bowel was 50 cm in length, confirming the diagnosis of congenital SBS. Parenteral nutrition was initiated and enteral feeding with an amino acid-based formula containing long-chain fatty acids was introduced early and gradually advanced. At the last follow-up examination at 24 months, he was thriving on a regular diet, with normal growth and development. Long-term survival of children with congenital SBS is now possible if enteral feeds are introduced early to promote intestinal adaptation, with subsequent weaning off parenteral nutrition.

The Use of Multiple Serial Transverse Enteroplasty (STEP) Procedures for the Management of Intestinal Atresia and Short Bowel Syndrome

2013 ◽  
Vol 79 (8) ◽  
pp. 826-828 ◽  
Author(s):  
Varun K. Bhalla ◽  
Walter L. Pipkin ◽  
Robyn M. Hatley ◽  
Charles G. Howell
Keyword(s):  
Small Bowel ◽  
Short Bowel Syndrome ◽  
Intestinal Transit Time ◽  
Small Bowel Length ◽  
Short Bowel ◽  
Jejunal Atresia ◽  
Repeat Procedure ◽  
Step Procedure ◽  
Primary Procedure ◽  
Serial Transverse Enteroplasty

The serial transverse enteroplasty procedure (STEP) was introduced as a bowel-lengthening procedure to reduce complications related to short bowel syndrome (SBS). Although some have described it as a useful adjunct to the Bianci procedure, others have acknowledged it as a primary procedure. We present a case of jejunal atresia in which two STEP procedures were performed 7 months apart to increase small bowel length. A 1-day-old, term girl presented with a known bowel obstruction diagnosed in utero. A laparotomy revealed a Type IIIb jejunal atresia with no remaining small bowel or cecum. A STEP procedure with an end jejunostomy and ascending colon mucous fistula lengthened the small bowel from 35 to 50 cm. A repeat procedure 7 months later lengthened it to 89 cm. The STEP procedure results in slower intestinal transit time and increases enterocytes contact with oral intake. We performed it during our initial exploration to increase small bowel size by 30 per cent. A repeat procedure 7 months later increased length to 89 cm. The use of multiple, staged STEP procedures avoided the need for bowel transplantation and long-term total parenteral nutrition dependence, demonstrating its effectiveness as a primary procedure for the surgical management of SBS.

scholarly journals Early effectivity of teduglutide for the treatment of short bowel sydrome – our first clinical experience

2021 ◽  
pp. 230
Author(s):  
◽  
◽  
Keyword(s):  
Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Treatment Effectiveness ◽  
Intestinal Adaptation ◽  
Standard Of Care ◽  
Home Parenteral Nutrition ◽  
Short Bowel ◽  
Post Surgery ◽  
Advanced Therapy ◽  
New Treatment

Background Short bowel syndrome is an uncommon malabsorptive condition most frequently caused by massive surgical resection of the small intestine. Standard of care is home parenteral nutrition. Teduglutide, glucagon like peptide 2 analog, was approved to treat patients with short bowel syndrome, who are stable following a period of post-surgery intestinal adaptation. Case presentation We report two cases of patients with short bowel syndrome on home parenteral nutrition, treated with teduglutide, novel advanced therapy. We monitored the effectiveness and tolerance of the new treatment. Conclusion Teduglutide increases intestinal absorption, causes cryptal hyperplasia, villous hypertrophy, angiogenesis, and allows weaning from parenteral nutrition. We confirmed the early onset of treatment effectiveness in the 4th month. Early effectiveness of treatment allowed a reduction in the volume of home parenteral nutrition with an improvement in quality of life.

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