[Rapid adaptation response after extensive resection of the small intestine: case report]

Short-gut syndrome is defined as any of the malabsorptive conditions resulting from massive resection of small bowel. Clinically the syndrome is manifested by malnutrition, weight loss; steatorrhea, and diarrhea that occur because of decreased absorptive capacity. Intestinal failure is the end result of several complex interacting mechanisms relating in: reduced enterocyte mass, short small bowel length (8-15% of normal) with consequent reduced mucosal contact time for absorption, massive proximal loop dilatation with poor propulsion. Intraluminal stasis and bacterial overgrowth cause bacterial translocation to the liver and "liver injury" presents as intrahepatic cholestasis, with rapid onset and relentless in its progression to end stage hepatic failure. Patients with short bowel must be totally or partly supported with intravenous nutrition until enteral absorption can sustain survival and growth. Autologous bowel reconstruction attempts to reconfigure the residual bowel to eliminate negative factors of bowel dilatation and stasis, and to redistribute the absorptive mucosa to enhance the adaptation response.

A case of a newborn with extensive small bowel resection (about 80%) because of malrotation with volvulus and bowel gangrene is presented. The newborn had been six days on total parenteral nutrition and then enteral nutrition had been started. The adaptation response on twentieth day had been satisfactory so that parenteral nutrition was completely suspended. Full adaptation was achieved after two months when the child had one yellow colored bowel movement per day. Presently, the baby grows normally and gains weight.

What makes this case interesting is a really unusually rapid adaptation response towards complete enteral independence.