Short bowel syndrome in infancy and childhood. Analysis of survival in 60 patients
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This study of 60 children with short bowel syndrome, often from necrotizing enterocolitis, found an 85% survival rate. Management involved surgical interventions and nutritional support, with adaptation taking 3-14 months.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Care
Background:
- Short bowel syndrome (SBS) is a severe condition in infants and children, frequently resulting from necrotizing enterocolitis.
- Management of SBS requires complex surgical and nutritional strategies to promote intestinal adaptation and survival.
Purpose of the Study:
- To report on the surgical management and outcomes of 60 pediatric patients with short bowel syndrome.
- To identify factors influencing intestinal adaptation and survival in this cohort.
Main Methods:
- Surgical interventions included bowel resection, tapering enteroplasty, primary anastomosis, and temporary enterostomies.
- Nutritional support involved total parenteral nutrition (TPN) and early enteral feedings, with home hyperalimentation initiated when enteral intake reached 50% of caloric needs.
- Second-look laparotomy was utilized in cases of uncertain bowel viability.
Main Results:
- The mean length of remaining small bowel was 58.4 cm.
- Intestinal adaptation ranged from 3 to 14 months.
- The overall survival rate was 85%, with mortality primarily linked to liver failure and sepsis associated with TPN.
Conclusions:
- Surgical management of short bowel syndrome in children requires a multidisciplinary approach, including TPN and early enteral feeding.
- Complications such as catheter sepsis, infections, and liver dysfunction are significant challenges.
- Despite challenges, a high survival rate is achievable with appropriate management.
Abstract:
This report concerns 60 infants and children with short bowel syndrome, most commonly caused by necrotizing enterocolitis in this study. Resection of atretic or gangrenous bowel was performed in 53 patients, tapering enteroplasty and primary anastomosis was performed in 13 patients, and temporary enterostomies were performed in 40 patients. Second-look laparotomy was useful in two of four cases of questionable bowel viability. The ileocecal valve was resected in 33 patients and remained intact in 27. The mean length of remaining bowel was 58.4 cm (range 13 to 150 cm). Seven patients with total aganglionosis and mid to proximal small bowel extension were managed with an initial enterostomy, whereas three had a pull-through procedure with an aganglionic patch enteroplasty. All patients received total parenteral nutrition and early enteral feedings. Home hyperalimentation was attempted when 50 percent of the calorie intake was enteral. Intestinal adaptation required from 3 to 14 months. Frequent setbacks were related to catheter sepsis, rotavirus infection, carbohydrate intolerance, and liver dysfunction. The overall survival rate was 85 percent, with mortality due to liver failure and sepsis associated with total parenteral nutrition.