Interposed Colon between Remnants of the Small Intestine Exhibits Small Bowel Features in a Patient with Short Bowel Syndrome

Abstract

We describe herein the case of a 48-year-old man who underwent emergency massive resection of the small intestine due to a strangulated ileus, which led to short bowel syndrome (SBS), as he was left with only 7 cm of jejunum and 8 cm of ileum with ileocecal valve. He then received interposition of a colon segment between the jejunum and ileum remnants isoperistaltically. For 24 months after the operation, he has been able to tolerate oral intake, but still requires partial home parenteral nutritional support during the night on a bimonthly basis. Biochemical and nutritional parameters, including the analysis of minerals and trace elements, indicated that the patient was in relatively good health. Histological examination revealed that the mucosa of the interposed colon showed hypertrophy and hyperplasia of the crypt glands, and cells resembling Paneth cells which are usually seen in the small intestine, suggesting that the colon segment exhibits adaptive changes to the small intestine. Colon interposition may be a useful technique in patients with SBS when the small bowel is too short for the other surgical considerations.

Short bowel syndrome in children: Surgical and medical perspectives

“…Interposed colonic segments absorb water, electrolytes, and nutrients in addition to their effect on intestinal transit. 33 In experimental studies, isoperistaltic colon interposition generally resulted in slower transit time, less weight loss, and improved survival after resection. Results with antiperistaltic colon interposition, however, have been less consistent.…”

Current Management of Short Bowel Syndrome

“…Although it has been suggested that interposed colon might develop structural and functional similarities to the small intestine, this has not been substantiated. 224 In experimental studies, isoperistaltic colon interposition generally resulted in slower transit time, less weight loss, and improved survival after resection. Results with antiperistaltic colon interposition, however, have been less consistent.…”

“…The use of colon interposition has been reported in 12 SBS patients, 11 of whom had isoperistaltic interposition. 215,224,225 Eleven of these patients were infants younger than 1 year of age. The interposed colon segment varied between 8 and 24 cm in length.…”

Update on surgical therapies for intestinal failure

“…Follow-up of the interposed segments indicate adaptation of the colon to its new location by hypertrophy and hyperplasia of the mucosal crypt glands, appearance of cells resembling small bowel Paneth cells [32], and alterations in contractile responses that become similar to those of the remaining small bowel [33]. small bowel, has likewise shown utility to delay transit time, enabling better fluid and electrolyte absorption.…”