[Significance and characteristics of enteral nutrition in massive intestinal resections]

There is an increasing number of patients who have lad massive resection of the small intestine, and they pose a problem of how to readapt their nutrition. This has to take into account their malabsorption syndrome due to the extent and site of the resection. Other factors which may affect their nutritional status are whether the caecum has been left in place, the functional capacity of the remaining small intestine and the hepatic and pancreatic functions. This process of readaptation is luckily helped by the compensating hyperplasia of the remaining small intestine especially clearcut in the ileum. This organ and this process is closely related to the presence of food and biliary pancreatic secretions in the intestinal lumen. This is a strong argument in favour of early oral feeding of these patients. It should start two to three weeks after the operation with at the same time intravenous feeding being continued until such time as the intestine can adequately take over. Nevertheless at the beginning simple food is used, which can be absorbed directly (glucose, amino acids, medium chain triglycerides--MCT). These are given slowly and continuously by a silicon nasogastric tube. After some time when the patient has become used to this, he can be fed orally to a slightly greater extent, with the food divided into five or six meals.