Adult patient living 32 years with postduodenal remnant small bowel of only 35 cm in jejunocolic anastomosis type II weaned off parenteral nutrition. A case report
| Autor: | Hassan Sabra, Mersad Alimoradi, Marwan M. Haddad, Georges Chahine, Etienne El-Helou, Jessica Naccour |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Abdominal pain ER emergency room Intestinal adaptation Physical examination Anastomosis Enteral administration Article IF intestinal failure 03 medical and health sciences 0302 clinical medicine Abdominal guarding Case report medicine Bowel length SBS short bowel syndrome medicine.diagnostic_test BaFT barium follow-through business.industry Short bowel syndrome medicine.disease Small bowel Parenteral nutrition ICU intensive care unit Surgery CT computed tomography Mesenteric ischemia 030220 oncology & carcinogenesis DVT deep venous thrombosis CRP C-reactive protein TSBL total small bowel length ABG arterial blood gas 030211 gastroenterology & hepatology medicine.symptom VS versus business IV intravenous |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| Popis: | Highlights • The small intestine is an essential constituent of the digestive system and plays a major role in the absorption of nutrients. • Acute mesenteric ischemia remains an emergency case. • Failure to adapt and the inadequate nutritional supply result in Short bowel syndrome. • A minimal indispensable length is required for nutritional autonomy. • Parenteral Nutrition still presents a pertinent problem of complications, charges and impairment in quality of life. Introduction The small bowel is an essential organ for maintaining adequate nutrition. Decrease in length could be associated with malnutrition and may require that the patient receives parenteral nutritional support. We report a case of a 59-year-old man who survived32 years with a short bowel of 35 cm length without any parenteral nutrition. Case presentation A 59-year-old gentleman, with a history of hypercoagulable state, presented for severe abdominal pain and obstipation of one day's duration. Upon presentation, the patient was hemodynamically unstable, with abdominal guarding and tenderness upon physical examination. Laboratory studies showed metabolic acidosis with leukocytosis and electrolyte disturbances, and an abdominal CT scan showed thickening of the sigmoid and multiple air-fluid levels. The patient was operated urgently for suspicion of mesenteric ischemia, however, he was found intraoperatively to have a very short dilated small bowel with jejunotransverse anastomosis. Discussion The necessity for surgical resection of the small bowel can arise for a sum of reasons. However, the removal of a big amount of small bowel may not be adaptive and appropriate digestion will no more be possible. In the aftermath of the resection, patients require parenteral nutrition for a certain period after which they may switch to enteral and oral nutrition, and subsequently intestinal adaptation by thickening and growth of the remaining intestinal villi. Conclusion Patients with a short bowel, particularly those surgically removed, can survive even with a very short remaining bowel length, as a result of intestinal adaptation, nutrition enhancement, and elimination of parenteral nutrition. |
| Databáze: | OpenAIRE |
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