Pediatric intestinal failure due to firearm injury: A case series

Pediatric short bowel syndrome (SBS) is often secondary to congenital conditions such as malrotation with midgut volvulus, intestinal atresia, gastroschisis, or necrotizing enterocolitis. Traumatic injury secondary to firearms is a less common cause of SBS encountered in the United States. We aim to describe the morbidity affecting four children (ages 9-16 years) with SBS secondary to firearm injury.

All patients had extensive injury directly to the bowel and/or the intestinal blood supply, requiring parenteral and/or enteral nutrition at discharge. All patients had significant extra-intestinal manifestations, including peripheral neuropathy and biliary strictures, but did not exhibit changes seen with intestinal failure-associated liver disease. Two patients identified issues with food insecurity, reliable transportation, and difficulty adhering to the treatment plan due to low health literacy. All four had ongoing post-traumatic psychological needs. Two patients had encounters with law enforcement after discharge, with one patient requiring physicians advocating for continued treatment with parenteral nutrition while incarcerated.

Firearm violence is the leading cause of pediatric death in the United States, but the morbidity endured by survivors, particularly those with SBS, is often not described. In addition to intestinal failure, we highlight this vulnerable population's medical, social, and psychological needs.