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[Long term prognosis after massive small bowel resection in children]
1Department of Pediatric Surgery, Osaka University Medical School, Japan.
Insights
Long-term prognosis for pediatric short bowel syndrome patients is positive, with most achieving normal growth and oral feeding after intensive nutritional support. Some metabolic complications may still occur.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Nutritional Science
Context:
- Massive small bowel resection in children can lead to short bowel syndrome.
- Congenital intestinal atresia and midgut volvulus are primary causes.
- Assessing long-term outcomes is crucial for patient management.
Purpose:
- To evaluate the long-term prognosis of pediatric patients surviving massive small bowel resection.
- To identify factors influencing growth, nutritional independence, and complications.
Summary:
- Eight survivors of massive small bowel resection (27-75 cm residual intestine) were studied for 2-19 years.
- Most patients achieved nutritional independence (oral meals or enteral formula) and near-normal somatic growth with intensive support.
- D-Xylose absorption improved, but fat absorption was impaired with <45 cm residual intestine. Late metabolic complications occurred in three cases.
Impact:
- Demonstrates the potential for good long-term outcomes in pediatric short bowel syndrome with appropriate care.
- Highlights the importance of nutritional support in achieving growth and independence.
- Identifies residual bowel length as a key factor for absorption and potential complications.
Abstract:
Eight survivors after massive small bowel resection were reviewed for a period of 2 to 19 years to assess the long term prognosis of patients. The primary diseases of short bowel syndrome were congenital intestinal atresia (6) and midgut volvulus (2). The length of the residual small intestine ranged between 27 and 75 cm and ileocecal valve was also resected in 3 cases. All cases had been already weaned from parenteral nutrition and six children tolerate normal meals and two have still enteral formula at home now. Near normal somatic growth was achieved in cases which received intensive nutritional supports after operation. The D-Xylose absorption test revealed gradual improvement except one with the shortest intestine (27 cm) and fat absorption was disturbed in patients who had less than 45 cm residual intestine. Late metabolic complications, such as renal calculus, cholelithiasis and pathologic fractures were encountered in three cases.