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

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

BMC Surgery ◽

10.1186/s12893-021-01454-2 ◽

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.

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Long-Term Outcome of Children with Short Bowel Syndrome Treated with a Modification of the STEP Technique Avoiding Mesenteric Defect

European Journal of Pediatric Surgery ◽

10.1055/s-0041-1735163 ◽

2021 ◽

Author(s):

Javier Bueno ◽

Laura García-Martínez ◽

Susana Redecillas ◽

Oscar Segarra ◽

Manuel López

Keyword(s):

Short Bowel Syndrome ◽

Bacterial Overgrowth ◽

Central Line ◽

Term Outcome ◽

Long Term Outcome ◽

Short Bowel ◽

Mesenteric Defects ◽

Multiple Ulcers

Abstract Background The Serial Transverse Enteroplasty Procedure (STEP) Registry has reported a 47% success to achieve enteral autonomy in pediatric short bowel syndrome (SBS). We have performed the STEP with a technical modification (MSTEP) consisting in stapler application without mesenteric defects that can also be applied to the duodenum. Our experience with this technique is described. Materials and Methods In this study, 16 children with SBS underwent MSTEP (2005–2019). Indications were nutritional autonomy achievement (n = 11, with duodenal lengthening in 5/11) and bacterial overgrowth treatment (n = 5). Results With a median follow-up of 5.8 years (0.7–13.7 years), 5 of 11 (45%) patients achieved enteral autonomy, 4 of them with duodenal lengthening. Four of four who preserved > 50% colon, while only one of seven with < 50% of colon achieved enteral autonomy (p < 0.05). After redo procedures, three of four attained enteral autonomy. Thus, 8 of 11 (73%) progressed to enteral autonomy, including all with duodenal lengthening. One child, already parenteral nutrition free, died due to central line sepsis. All the patients from the bacterial translocation group improved their metabolic/nutritional status, but one required subsequent enterectomy of the lengthened intestine due to multiple ulcers in the staple lines. Conclusion The effectiveness of MSTEP to achieve enteral autonomy seems similar to the classical STEP. It can be applied to the duodenum. The retained colon length may influence the post-STEP enteral autonomy achievement.

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Preemptive Cautions Prior to Final İntestinal Transplantation: Four Golden Criteria in Predicting the Outcome and Long-Term Survival of Short Bowel Syndrome: Is the Remaining Bowel Length is at or above 50 Cm? Can Patient Survive Over 24 Months in spite of any Complications? Younger Age? and Lesser Accompanying Co-Morbidity?

International Journal of Transplantation Research and Medicine ◽

10.23937/2572-4045.1510043 ◽

2019 ◽

Vol 5 (2) ◽

Author(s):

Unal Ethem

Keyword(s):

Short Bowel Syndrome ◽

Intestinal Transplantation ◽

Term Survival ◽

Long Term Survival ◽

Short Bowel ◽

Bowel Length ◽

Younger Age ◽

Co Morbidity

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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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