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Cutoffs and Characteristics of Abnormal Bowel Dilatation in Pediatric Short Bowel Syndrome
Oona Nieminen1, Maria Hukkinen1, Reetta Kivisaari2
1From the Department of Pediatric Surgery, Pediatric Liver and Gut Research Group, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Insights
In pediatric short bowel syndrome (SBS), intestinal dilatation is common. Duodenal dilatation, specifically, is linked to longer parenteral nutrition (PN) dependence in children not yet having reconstructive surgery.
Area of Science:
- Pediatric Gastroenterology
- Intestinal Adaptation
- Surgical Outcomes
Background:
- Pediatric short bowel syndrome (SBS) is a complex condition often requiring long-term nutritional support.
- Excessive intestinal dilatation is recognized as a complication in SBS, but its natural history and definition remain unclear.
- Understanding intestinal dilatation patterns is crucial for predicting outcomes in children with SBS.
Purpose of the Study:
- To define pathological intestinal dilatation in children with SBS who have not undergone autologous intestinal reconstructive (AIR) surgery.
- To investigate the natural history of foregut, midgut, and hindgut dilatation in relation to controls.
- To assess the predictive value of intestinal diameter ratios for weaning off parenteral nutrition (PN).
Main Methods:
- A retrospective study included 59 children with SBS (no prior AIR surgery) and 140 age-matched controls.
- Maximum diameters of the duodenum, small bowel (SB), and colon were measured from contrast series and expressed as diameter ratios (DR) to L5 vertebrae height.
- Cox proportional hazards regression models were used to analyze the predictive ability of DR for PN weaning.
Main Results:
- SBS patients exhibited significantly higher duodenum (DDR), SB (SBDR), and colon (CDR) DR compared to controls (P < 0.01 for all).
- Maximal DDR and SBDR correlated with current PN dependence and younger age.
- A maximal DDR below 1.5 (99th percentile for controls) predicted a 2.5-fold increased likelihood of weaning off PN (P = 0.005).
Conclusions:
- All intestinal segments, particularly the SB, dilate in children with SBS.
- In SBS patients without AIR surgery, duodenal and small intestinal dilatation are associated with PN dependence and younger age.
- Duodenal dilatation is a significant predictor of prolonged PN, highlighting its importance in SBS management.
Objectives:
Although excessive intestinal dilatation associates with worsened outcomes in pediatric short bowel syndrome (SBS), little is known about the natural history and definition of pathological dilatation. We addressed fore-, mid-, and hind-gut dilatation in children with SBS, who had not undergone autologous intestinal reconstructive (AIR) surgery, in relation to controls.
Methods:
SBS children without history of AIR surgery (n = 59) and age-matched controls without any disclosed intestinal pathology (n = 140) were included. Maximum diameter of duodenum, small bowel (SB), and colon were measured in each intestinal contrast series during 2002 to 2020 and expressed as diameter ratio (DR) to L5 vertebrae height. Predictive ability of DR for weaning off parenteral nutrition (PN) was analyzed with Cox proportional hazards regression models using multiple cutoffs.
Results:
Duodenum (DDR), SB (SBDR), and colon (CDR) DR were 53%, 183%, and 23% higher in SBS patients compared to controls ( P < 0.01 for all). The maximal DDR and SBDR measured during follow-up is associated with current PN dependence and young age. DDR correlated with SBDR ( r = 0.586, P < 0.01). Patients with maximal DDR less than 1.5, which was also the 99th percentile for controls, were 2.5-fold more likely to wean off PN ( P = 0.005), whereas SBDR and CDR were not predictive for PN duration.
Conclusions:
All segments of remaining bowel, especially SB, dilate above normal levels in children with SBS. In SBS children without AIR surgery, PN dependence and young age is associated with duodenal and small intestinal dilatation, while duodenal dilatation also predicted prolonged PN.
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