Treatment of short bowel syndrome in children. Value of the Intestinal Rehabilitation Program

Abstract

The main cause of acute intestinal failure is short bowel syndrome, generally as a result of resection of extensive segments of small intestine. As a result, the main symptoms are watery diarrhea, malabsorption syndrome, chronic malnutrition, and death, if the patient is not properly treated. If the length of the remaining intestine is greater than 30 cm, complete adaptation is possible and the patient may not require parenteral nutrition. The currently recommended treatment includes the use of prolonged parenteral nutrition and enteral nutrition, always aimed at constant weight gain, in conjunction with surgeries aimed at elongating the dilated bowel. This set of procedures constitutes what is called an Intestinal Rehabilitation Program. This therapy was used in 16 children in periods ranging from 8 months to 7.5 years, with survival in 75% of the cases. Finally, the last resort to be used in children with complete resection of the small bowel is an intestinal transplant. However, to date there is no record of a Brazilian child that has survived this procedure, despite it being attempted in seven patients. We conclude that the results of the intestinal rehabilitation program are encouraging for the continuation of this type of treatment and stimulate the creation of the program in other pediatric care institutions.

Ultrasound of portal venous gas in a child with short bowel syndrome

“…Management of children with SBS involves three phases: the initial acute phase after the surgical procedure, which includes ileus and intestinal hurry and lasts up to 4 weeks; the adaptation phase, which lasts from a few months to 1 year; and the maintenance phase . In the present case, PVG occurred during the adaptation or maintenance phase during which patients receive parenteral nutrition.…”

“…In the adaptation phase, increased blood flow to the remaining intestine, intestinal growth and dilatation, and increased absorption surface occur . Additionally, bacterial overgrowth and translocation occur because of compensatory intestinal dilatation, increase in unabsorbed carbohydrates, and mucosal atrophy due to intestinal dysmotility in children with SBS . These conditions in children with SBS may be similar to the environment that has previously been associated with the occurrence of PVG .…”

“…In the present case, PVG occurred during the adaptation or maintenance phase during which patients receive parenteral nutrition. In the adaptation phase, increased blood flow to the remaining intestine, intestinal growth and dilatation, and increased absorption surface occur . Additionally, bacterial overgrowth and translocation occur because of compensatory intestinal dilatation, increase in unabsorbed carbohydrates, and mucosal atrophy due to intestinal dysmotility in children with SBS .…”

“…Additionally, bacterial overgrowth and translocation occur because of compensatory intestinal dilatation, increase in unabsorbed carbohydrates, and mucosal atrophy due to intestinal dysmotility in children with SBS . These conditions in children with SBS may be similar to the environment that has previously been associated with the occurrence of PVG . Thus, PVG may not be uncommon in children with SBS.…”

Hypothyroidism associated with short bowel syndrome in children: a report of six cases

“…The cases of six patients with SBS who presented changes in the HPT axis and hypothyroidism, during treatment of intestinal failure at the Children's Institute of the University of São Paulo School of Medicine, from 2012 to 2017, are reported herein. As far as we know, this is the first report of an expressive number of patients with such association although iodine deficiency associated to long-term parenteral nutrition is a wellknown condition and may be avoided by adequate intravenous administration of sodium iodine (20).…”