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[Short bowel syndrome]
N Calomino1, M Malerba, G Oliva
1Policlinico Le Scotte, Università degli Studi, Siena.
Insights
Two patients with intestinal infarct underwent extensive bowel resection, retaining 40-50 cm of intestine. Both successfully transitioned from artificial nutrition to a normal diet, achieving good quality of life.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Clinical Nutrition
Background:
- Intestinal infarct necessitates extensive bowel resection, potentially leading to short bowel syndrome.
- Preservation of the ileocecal valve (Bauin valve) is crucial for intestinal function but may not always be feasible due to prior surgery or disease.
- Management of short bowel syndrome requires careful nutritional support to ensure patient recovery and long-term well-being.
Observation:
- Two patients with intestinal infarct underwent significant intestinal resection, resulting in residual bowel lengths of 40 cm and 50 cm.
- In one case, the ileocecal valve was sacrificed during a previous operation for cecal neoplasm; in the other, it could not be preserved during the resection.
- Postoperatively, patients required intensive care followed by total parenteral nutrition, gradually transitioning to enteral nutrition and then an oral diet.
Findings:
- Patients successfully weaned off artificial nutrition (parenteral and enteral) after a period of intensive nutritional management.
- Both patients achieved stabilization with independent oral intake.
- A good quality of life was reported by both patients despite the extensive bowel resection and loss of the ileocecal valve.
Implications:
- Extensive intestinal resection for infarct, even with loss of the ileocecal valve, can be managed successfully with tailored nutritional strategies.
- Early and progressive nutritional rehabilitation is key to achieving independence from artificial nutrition and improving patient outcomes.
- This case series highlights the potential for recovery and good quality of life in patients with short bowel syndrome following major intestinal surgery.
Abstract:
In the last year at the Department of Surgery of the University of Siena two patients presenting a clinical feature of intestinal infarct have been operated. In these patients a wide intestinal resection has been performed. After this surgical operation, a patient had a residual tract of 40 cm of bowel and the other 50 cm. It was not possible during operation to preserve the Bauin valve in a case; in the other, this valve has been sacrificed during a previous operation for cecal neoplasm. In the postoperative period, patients were transferred temporarily in the intensive care unit, and after some days they returned to the department where total parenteral nutrition with progressive decreasing mixture in calories over time was administered. Enteral nutrition was also started and the quantity of water, calories and azote was slavly increased. In a second time an oral diet was started up to completely weaning from parenteral and then enteral nutrition. At present, these patients are enlisted in quarterly follow-up and are completely stabilized. They are independent from artificial nutrition and they have a good quality of life.