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Repeat STEP procedure to establish enteral nutrition in an infant with short bowel syndrome

Nobuyuki Morikawa1, Tatsuo Kuroda, Yoshihiro Kitano

  • 1Division of General Surgery, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, 157-8535, Japan. morikawa-n@ncchd.go.jp

Pediatric Surgery International
|August 22, 2009
PubMed

Insights

Serial transverse enteroplasty (STEP) is effective for short bowel syndrome. A second STEP can successfully treat intestinal dilatation and malabsorption, improving enteral nutrition tolerance in infants.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Intestinal Reconstruction

Background:

  • Short bowel syndrome (SBS) poses significant challenges in pediatric patients, often requiring surgical intervention.
  • The serial transverse enteroplasty (STEP) procedure is a recognized technique to increase the functional length of the small intestine.
  • Postoperative intestinal dilatation following STEP can lead to complications like bacterial overgrowth, malabsorption, and liver failure.

Observation:

  • This case study details an infant with SBS due to jejunal atresia who underwent two STEP procedures.
  • The initial STEP improved liver function, but subsequent intestinal dilatation necessitated a second intervention.
  • The second STEP procedure was crucial in enabling the patient to tolerate 80% of caloric intake enterally.

Findings:

  • Repeated STEP procedures can be safely performed in cases of recurrent or persistent intestinal dilatation after initial bowel lengthening.
  • Successful management of intestinal dilatation through a second STEP directly improved the patient's ability to receive enteral nutrition.
  • This intervention mitigated malabsorption and supported improved nutritional status in a complex pediatric SBS case.

Implications:

  • The findings suggest that a second STEP procedure should be considered when small bowel dilatation compromises enteral nutrition post-initial STEP.
  • This approach offers a viable strategy to manage complications of SBS and enhance long-term outcomes in pediatric patients.
  • Further research into optimizing STEP techniques and managing associated complications is warranted to improve SBS care.

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