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[Problems and difficulties in adapting period in infants and children after massive intestinal resection]
S Hasegawa1, Y Hirai, Y Sanada
1Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Insights
Children with massive intestinal resection face long-term nutritional challenges, including hepatic dysfunction and abnormal vitamin levels, requiring extended nutritional support. This highlights the need for careful monitoring and management post-surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Nutritional Science
Context:
- Massive intestinal resection in infants and children leads to significant intestinal adaptation challenges.
- Study included 17 survivors of 31 pediatric patients who underwent massive intestinal resection (residual intestine < 75 cm) between 1966-1987.
Purpose:
- To define the difficulties and problems encountered during intestinal adaptation after massive intestinal resection in pediatric patients.
- To investigate the long-term nutritional sequelae in survivors of massive intestinal resection.
Summary:
- Postoperative hepatic dysfunction was observed in 11 of 17 survivors, with reduced ileal length potentially contributing to its recurrence.
- Disturbances in bile acid reabsorption and rapid turnover persisted even after catch-up growth.
- Abnormal serum mineral levels during total parenteral nutrition (TPN) normalized with oral feeding, while vitamin deficiencies (Vitamins A, E, D3, B12) persisted into school age.
- Massive intestinal resection necessitates long-term nutritional care, particularly for lipid and vitamin management.
Impact:
- Identifies persistent nutritional deficiencies and hepatic dysfunction as key challenges following pediatric massive intestinal resection.
- Emphasizes the critical need for prolonged, specialized nutritional support, including lipid and vitamin supplementation, for affected children.
- Provides insights into the etiology of hepatic dysfunction related to ileal length and bile acid metabolism.
Abstract:
In the period of intestinal adaptation following massive resection of intestine, patients have several difficulties and problems. This study was done in 17 survivals of 31 infants and children received massive intestinal resection (residual intestine; less than 75 cm) between 1966-1987 to define these problems and difficulties. 1) Postoperative hepatic dysfunction occurred in 11 of the 17 survivals. The relationship between relapsing frequency of hepatic dysfunction and length of remaining ileal segment suggested that the reduced ileal length may be one of the etiologic factors of the hepatic dysfunction. 2) Evaluation of serum bile acid levels suggested that the disturbance of bile acid reabsorption and its rapid turn over might still remain even after catch-up growth of these patients. 3) Abnormal levels of serum minerals (Ca, InP, Mg, Zn and Cu) were observed in 4 cases during TPN, and these abnormalities disappeared by discontinuation of parenteral nutrition and beginning of oral feeding. 4) Serum vitamin levels (Vit.A, Vit.E, 25-OH-D3, and Vit.B12) still remained in abnormal even after the patients reached school age. These results suggested that very long-term nutritional cares, especially in lipid and vitamin nutrition, are necessary for the children with massive intestinal resection.