Short bowel syndrome against the background of adhesive disease of the abdominal cavity

Short bowel syndrome is a pathological symptom complex that occurs after removal (resection) of the small intestine (more than 25% of its length), or when there is a signifi cant violation of its function. The most common cause of short bowel syndrome is adhesions of the small intestine that occur after surgical interventions on the abdominal organs. A description of the clinical observation of short bowel syndrome with severe manifestations of enteric insufficiency in a 41-year old patient is given. The patient was admitted to the surgical Department of FGBUZ Central clinical of the hospital Russian Academy of Sciences with com-plaints of General weakness, pain, spastic nature in the abdomen without clear localization, pain in the area of operational wound (for 4 months had 4 surgery for adhesive intestinal obstruction), abdominal distention, thirst, dry mouth, semiliquid chair 3–4 times a day, weight loss for the last 7 months before the hospitalization at 22 kg, the body mass index was 17.3 kg/m2. After the last surgical intervention, ileostomy of the ascending colon was applied using the Brooke method in connection with adhesive small bowel obstruction. The functioning segment of the jejunum was anastomosed with the ascending colon and was 22 cm long. At admission, the state of moderate severity, moderately emaciated, dehydrated. Liquid stool up to 6 times a day, without pathological impurities. MSCT of abdominal organs from 03.05.2018 with contrast: in meso — and hypogastria (mainly on the left), expanded loops of the small intestine (up to a maximum of 37–38 mm) fi lled with liquid content were visualized, the contrast preparation in the above described loops of the small intestine was not visualized. Additionally, non-expanded loops of the small intestine were visualized in the hypogastria and did not contain contrast. Non-functional loops of the small intestine in the meso — and hypogastrium. Liver, biliary system, pancreas, spleen — without features. On the background of complex therapy, the stabilization of clinical and laboratory indicators was achieved, which allowed to plan surgical treatment-laparotomy, closure of ileostomy, imposition of small intestine anastomosis in the large intestine. A laparotomy was performed with the right pararectal access. Continuous viscero-visceral and of viscero-peritoneal splices were found in the abdominal cavity. With technical difficulties caused by fi brous-calcifi ed splices, it was possible to separate the ascending colon and the part of the jejunum that goes to the anterior abdominal wall to the site of the bred jejunostomy. The intersection of the jejunum stoma was performed in close contact with the anterior abdominal wall. A double-row “end-to-side” anastomosis was formed with the middle third of the ascending colon. When performing laparotomy with left pararectal access under conditions of a pronounced adhesive process, it was possible to isolate a section of the sigmoid colon and a loop of the small intestine that was previously disabled (during the previous operation). Ileosigmoidostomy formed a double row “side to side”. The preserved portion of the small intestine was 85 cm. In the postoperative period, there were signs of endogenous intoxication. Against the background of intestinal paresis and severe intoxication, there was an increase in the markers of infl amemation and pancytopenia. Complex therapy with parenteral mixtures, prebiotics and antimicrobial drugs stopped the symptoms of intoxication, the activity of infl ammation, and improved laboratory parameters, which allowed us to gradually switch to oral food intake. Semi-formed stool 1–2 times a day. She was discharged on the 10th day after the operation for outpatient treatment under the supervision of a surgeon and gastroenterologist. One-year rehabilitation period with a positive effect, which indicates the uniqueness of this clinical observation.

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POTENTIAL OF RADIODIAGNOSTIC METHODS FOR SMALL INTESTINE EXAMINATION IN THE CONTEXT OF SHORT BOWEL SYNDROME IN CHILDREN

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care ◽

10.30946/2219-4061-2019-9-1-17-36 ◽

2019 ◽

Vol 9 (1) ◽

pp. 17-36

Author(s):

R. R. Khasanov ◽

M. Weis ◽

R. A. Gumerov ◽

A. A. Gumerov ◽

L. M. Wessel

Keyword(s):

Magnetic Resonance Imaging ◽

Small Intestine ◽

Magnetic Resonance ◽

Short Bowel Syndrome ◽

Abdominal Cavity ◽

Resonance Imaging ◽

Short Bowel ◽

Advantages And Disadvantages ◽

Contrast Radiography ◽

Magnetic Resonance Imaging Mri

Objective. For many years such diagnostic techniques as ultrasonography (U/S), contrast radiography (CR) and magnetic resonance imaging (MRI) have been successfully applied for the diagnosis of gastrointestinal diseases in children. Despite the long experience with U/S, CR and MRI for small intestine examinations, their diagnostic yield is yet not defined in the context of the short bowel syndrome considering the evaluation of advantages and disadvantages of these methods. In this regard, the purpose of our research was to define the role of each of these methods as a matter of assessing and monitoring patients’ condition as well as diagnosis of complications in patients with short bowel syndrome. Methods. To determine the opportunities of U/S, CR and MRI diagnostics for detection of malconditions in cases of short bowel syndrome we examined patients who had undergone ultrasound, CR and MRI of the intestinal tract as part of preoperative preparation for elongation of small intestine. In order to assess the diagnostic efficacy of aforementioned methods in the context of short bowel syndrome research results were compared with data obtained during surgery. Results. Ultrasonography (U/S) is considered to be the best screening technique for patients with SBS. Contrast radiography (CR) provides an opportunity to research the morphology of small intestine and its transport function quite thoroughly. Magnetic resonance imaging (MRI) is a method which allows one to give the best possible estimate of morphology of small intestine. Conclusion. U/S, CR and MRI of abdominal cavity organs are effective methods when it comes to the examination of small intestine in short bowel syndrome; each of these screening techniques has its own strengths and weaknesses. However, a proper combination of these methods should be applied, as it allows one to perform a comprehensive diagnosis of changes in short bowel syndrome and to take appropriate and timely actions regarding further patients’ treatment.

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Multiple intestinal anastomosis in newborns and infants

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2021-25-3-153-157 ◽

2021 ◽

Vol 25 (3) ◽

pp. 153-157

Author(s):

Yu. A. Kozlov ◽

M. N. Mochalov ◽

K. A. Kovalkov ◽

S. S. Poloyan ◽

P. Zh. Baradieva ◽

...

Keyword(s):

Small Intestine ◽

Short Bowel Syndrome ◽

Necrotizing Enterocolitis ◽

Average Length ◽

Intestinal Anastomosis ◽

Abdominal Cavity ◽

Average Weight ◽

Intestinal Anastomoses ◽

Short Bowel ◽

Second Surgery

Introduction. The present trial systematizes data, taken from one surgical center as an example, on treating patients with intestinal atresia and necrotizing enterocolitis with multiple intestinal anastomoses.Material and methods. The trial is a retrospective review on the treatment of 13 newborn infants who since 2010 have been put multiple intestinal anastomoses; the treatment was approved by the Hospital Ethics Committee. The average gestational age of patients was 31.2 weeks. The average age at the time of surgery – 7,9 days. Average weight - 2007 grams. The average number of anastomoses was 3.7 (range: 2-7). The average length of remained small intestine after the second surgery was 67.4 cm (range: 12-120 cm). No other surgical procedures, including gastrostomy or enterostomy, were performed. In all cases, surgical intervention ended with hermetic suturing of the abdominal cavity. Among them, there were 6 patients with the multifocal form of necrotizing enterocolitis; 6 patients had type IV atresia of the small intestine; 1 patient had the Ladd’s syndrome. Connection of intestinal segments was made by constructing several “end-to-end” anastomoses, double-row precision seam with PDS II 7/0 suture.Results. In the postoperative period, complications associated with anastomosis construction, such as leakage and narrowing, were not recorded. Transit function of the gastrointestinal tract restored on day 4, on average, after the surgery (range: 2-6 days). There were no early lethal outcomes within the first 28 days after the surgery which were associated with the surgery. 2 patients with short bowel syndrome (remained small intestine was 12 and 25 cm) and multivisceral disorders died on day 72 and 64 after the surgery. Survived patients were transferred to full enteral feeding in 56 days, in average, after the second surgery (range - 15-120 days).Conclusion. In our study, we have demonstrated potentials of a new surgical approach: one-stage formation of multiple intestinal anastomoses in case of multiple intestinal atresias as well as in case of multifocal forms of necrotizing enterocolitis. Maintaining the bowel length with multiple bowel anastomoses is very important factor for better survival of patients with the short bowel syndrome.

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

Italian Journal of Medicine ◽

10.4081/itjm.2016.543 ◽

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.

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RARE CASE OF SHORT BOWEL SYNDROME

TSMU COLLECTION OF SCIENTIFIC WORKS ◽

10.52340/csw.v49i0.137 ◽

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.

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Short Bowel Syndrome

10.2310/gastro.5448 ◽

2015 ◽

Author(s):

Robert Burakoff ◽

Alison Goldin

Keyword(s):

Small Intestine ◽

Short Bowel Syndrome ◽

Average Length ◽

Intestinal Failure ◽

Clinical Manifestations ◽

Intestinal Resection ◽

Intestinal Atresia ◽

Congenital Defects ◽

Short Bowel ◽

Vascular Insufficiency

Short bowel syndrome (SBS) is a state of malabsorption resulting from physical or functional loss of large portions of the small intestine, and is the most common cause of intestinal failure. The average length of a human’s small intestine is between 3 and 8 m, depending on the type of measurements made (surgical, radiologic, or autopsy); SBS occurs when less than 200 cm of small bowel remains. SBS may be congenital (intestinal atresia) or acquired. Physical losses usually occur from surgical resection for Crohn disease (CD), vascular insufficiency, radiation, malignancy, trauma, or volvulus. The site of intestinal resection helps to determine the degree of intestinal capacity. Functional losses, on the other hand, are less common and occur in the setting of a nonfunctioning, but intact, small intestine. Examples include radiation enteritis, congenital defects, and inflammatory bowel disease (IBD). This review addresses the epidemiology, pathophysiology and pathogenesis, clinical manifestations, treatment, complications, and prognosis of SBS. A figure shows sites of intestinal nutrient absorption. A table lists potential complications of SBS in patients receiving parenteral nutrition (PN). This review contains 1 highly rendered figure, 1 table, and 67 references.

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