No Gut Syndrome: Near Total Enterectomy

Abstract

In adult patients, removal of the entire jejunum and ileum (a near total enterectomy (NTE)) is considered a non-survivable event as patients undergoing this procedure might also suffer from an underlying illness that will lead to bowel necrosis such as septic or cardiac shock and respiratory failure. Parenteral nutrition (PN) dependency with its associated complications and quality of life issues further complicates management decisions in this group of patients. In the following report, we discuss our institutional experience with NTE and present a comprehensive review of the literature with patients undergoing NTE with the establishment of bowel continuity and successful outcomes even in cases dating as far back as the 1950s, over a decade prior to the implementation of PN. Review of the literature revealed 26 cases of NTE. Most of these patients are young (46.7 years old), and 57 % are women. These patients were reported to be alive at 21 months of follow-up. In this report, we present an individual 51 months following NTE. We also document the oldest patient receiving an NTE (76 years old). Both of these patients are alive on home PN. In cases where there is hemodynamic stability and patients request to continue with further care, the possibility of a NTE with bowel continuity and life-long PN might be entertained.

More on ‘No Gut Syndrome’: A case report

“…However, it has been observed that with the passage of time these episodes gradually reduce in frequency as well as severity [15] , [16] . Our previous experiences along with our experience in this case as well, have been encouraging in this regard [2] . Other options are also available, but have not been as successful.…”

“…We therefore feel, this entity needs to continue being reported so that previous results and subsequent decisions can be discussed with the patient and patient’s family should this scenario occur in clinical practice. We have previously reported two cases and a review of literature on patients who have undergone a NTE and have been successfully maintained on PN [2] . Since then we have managed an additional case that has been reported here in a similar manner and found an additional citation in the literature [4] .…”

“…As opposed to SBS, this entity leaves the patient without sufficient length of bowel to undergo adaptive changes and, therefore, these patients must rely on life-long parenteral nutrition (PN). We have previously reviewed the literature on this condition [2] . However, we continue to observe similar cases, both, in the literature and in our clinical practice.…”

Duodenocolostomy as Treatment of Ileus in Short Bowel Syndrome: A Case Report

“…Although formation of a duodenocolic anastomosis is unusual, some reports support its effectiveness in restoring intestinal continuity. A recent review analyzed 28 patients who underwent total small bowel resection in the last 70 years [ 4 ]. Establishment of bowel continuity by means of a duodenocolic anastomosis was shown to be a viable option in hemodynamically stable patients.…”

Distal Duodenogastrostomy or Proximal Jejunogastrostomy in the Management of Ultra-Short Bowel

“…1 If feasible, an anastomosis between the duodenal stump and colon can be made in cases in which after near total enterectomy the colon is still well vascularized. 2 However in severe cases with more extensive or even near total enterectomy, the duodenal stump may be too short for external stoma creation of too poor condition to restore bowel continuity or there may be too little bowel available to restore continuity at all. In these cases, prevention of blow out of the stump is crucial.…”