Download MBBS Pediatric Surgery Presentations 3 Short Gut And Intestinal Failure In Pediatric Surgery Lecture Notes

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FAILURE IN PEDIATRIC SURGERY

SHORT BOWEL SYNDROME

The decreased absorptive

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ability of intestines- either

due to short length or

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functional reduction due to

diseases- jeopardizing

survival.

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Due to:
1. Congenital gut defects
2. Malabsorptive diseases
3. Surgical removal of long

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segments of intestines


Normal bowel length

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Neonatal: 200-300 cm
Children:


Adult : 700-800 cm

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SHORT BOWEL SYNDROME

Various definitions:

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1. 50% or more of the small bowel resected.
2. When Ileocaecal valve is present: 25-30 cm
When ileocaecal valve is absent: 40cm

If Ileocaecal valve is lost,

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transit time is faster and loss
of fluid and nutrients is greater.

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ETIOLOGY

Necrotising enterocolitis (35%)

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Intestinal atresias (25%)

Gastroschisis (18%)

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Malrotation with midgut
volvulus (14%)

Long segment Hirschsprung's(2%)
Others (6%)

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NECROTISING ENTEROCOLITIS (35%)

One of the most common gastrointestinal emergencies in the

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newborn infant.

Premature neonates that results in inflammation and bacterial

invasion of the bowel wall.

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INTESTINAL ATRESIAS (25%)

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Congenital complete blockage or obstruction anywhere in the

intestine.

Duodenal, jejunal, ileal- usually treated by resection and end

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to end anastomosis.

Some develop severe
disruption- large part atretic.

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In about 10%- lack dorsal

mesentery and assume a

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spiral like an `apple peel'

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GASTROSCHISIS (18%)

Fetal bowel eviscerates through a narrow

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abdominal wall defect.

Exposed to amniotic fluid;

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associated with other malformations;

tight abdominal compartment.

MALROTATION WITH MIDGUT VOLVULUS

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MANAGEMENT

Requires a multi-disciplinary approach that includes

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- neonatologists,

- gastroenterologists,
- surgeons,

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- nutritionists,
- pharmacists,
- stomal therapists,
- nurses, etc.

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SURGICAL MANAGEMENT

1. Bowel conservation at initial presentation.
2. Bowel lengthening surgeries.
3. Intestinal transplantation.

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BOWEL LENGTHENING SURGERIES

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Longitudinal intestinal
lengthening and tailoring
(LILT) procedure(BIANCHI 1980).

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- Doubles bowel length.
- Improves peristalsis.

- Anastomotic leak
- Anastomotic stenosis

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- Fistula formation
- Sepsis

BOWEL LENGTHENING SURGERIES

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Serial Transverse Enteroplasty

(STEP) ? creates a longer and

narrower intestine.

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- - Staple line leak
- Hematoma
- Bowel obstruction
- Abscess

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INTESTINAL TRANSPLANTATION

Last resort in irreversible liver and intestinal failure.

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Types :
1.

Isolated intestine

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2.

Combined intestine and liver

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3.

Multivisceral

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INTESTINAL TRANSPLANTATION

Complications

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- Acute rejection,

- Infection,

- Graft-versus-host disease, and

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- Post-transplant lympho-proliferative disease.