Irreversible Intestinal Failure

Abstract

Intestinal failure (IF) can be defined as the reduction of functional gut mass below the minimal amount necessary for digestion and absorption adequate to satisfy the nutrient and fluid requirements for maintenance in adults or growth in children. In developed countries, IF mainly includes individuals with the congenital or early onset of conditions requiring protracted or indefinite parenteral nutrition (PN). Short bowel syndrome was the first commonly recognized cause of protracted IF. The normal physiologic process of intestinal adaptation after extensive resection usually allows for recovery of sufficient intestinal function within weeks to months. During this time, patients can be sustained on parenteral nutrition. Only a few children have permanent intestinal insufficiency and life-long dependency on PN. Non-transplant surgery including small bowel tapering and lengthening may allow weaning from PN in some cases. Hormonal therapy with recombinant human growth hormone has produced poor results while therapy with glucagon-like peptide-2 holds promise. Congenital diseases of enterocyte development such as microvillus inclusion disease or intestinal epithelial dysplasia cause permanent IF for which no curative medical treatment is currently available. Severe and extensive motility disorders such as total or subtotal intestinal aganglionosis (long segment Hirschsprung disease) or chronic intestinal pseudo-obstruction syndrome may also cause permanent IF. PN and home-PN remain are the mainstays of therapy regardless of the cause of IF. Some patients develop complications while receiving long-term PN for IF especially catheter related complications (thrombosis, sepsis) and liver disease. These patients may be candidates for intestinal transplantation. This review discusses the causes of irreversible IF and emphasizes the specific medico-surgical strategies for prevention and treatment of these conditions at several stages of IF.

Aseptic non‐touch technique and catheter‐related bloodstream infection in children receiving parenteral nutrition at home

“…1 Children with IF depend on parenteral nutrition (PN) for their calories and nutritional needs. Home PN is usually initiated in children when the underlying disease leading to IF does not respond to treatment and it becomes apparent that PN is likely to be needed for at least three months.…”

Generation of intestinal surface: an absorbing tale

“…Significant loss of this surface area can lead to malabsorption or intestinal failure, which is defined as insufficient nutritional uptake to sustain homeostasis (in adults) or growth (in children) (Goulet et al, 2004). Treatment of this condition generally requires prolonged intravenous nutritional supplementation ( parenteral nutrition).…”

Predictive factors at birth of the severity of gastroschisis

“…Prolonged TPN, with its risk of sepsis, is directly related to intestinal recuperation, and the morbidity of GS is closely related to intestinal damage [20] . While gastrointestinal complications such as matting between the loops, malrotation, volvulus, perforations and atresia increase the complexity of early management [19,21] , later management may be complicated by the presence of problems of absorption, intestinal dysmotility, obstruction, NEC, infarction and stenosis [1,3,9] . The pathogenesis of secondary bowel lesions is not fully understood, but both chemical and mechanical origins are concerned [2] .…”

“…The pathogenesis of secondary bowel lesions is not fully understood, but both chemical and mechanical origins are concerned [2] . We know that prolonged contact with the amniotic fluid is deleterious for the bowel and may lead to inflammation of the bowel wall resulting in the production of a yellow fibrous tissue named peri visceritis [21,22] . This perivisceritis is accompanied by edema, cellular infiltration of epithelial cells and the presence of macrophages in the bowel wall.…”