Clin Nutr Res.  2013 Jul;2(2):149-153. 10.7762/cnr.2013.2.2.149.

Nutritional Support Process for a Patient with Short Bowel Syndrome in Conjunction with Panperitonitis: A Case Report

• Kim SJ
• Kim BR
• Lee SM
• Kong HJ
• Shin CS

• KMID: 2279670
• DOI: http://doi.org/10.7762/cnr.2013.2.2.149

Abstract

Short Bowel Syndrome (SBS) is a condition that causes malabsorption and nutrient deficiency because a large section of the small intestine is missing or has been surgically removed. SBS may develop congenitally or from gastroenterectomy, which often change the motility, digestive, and/or absorptive functions of the small bowel. The surgical procedure for SBS and the condition itself have high mortality rates and often lead to a range of complications associated with long-term parenteral nutrition (PN). Therefore, careful management and appropriate nutrition intervention are needed to prevent complications and to help maintain the physiologic integrity of the remaining intestinal functions. Initial postoperative care should provide adequate hydration, electrolyte support and total parenteral nutrition (TPN) to prevent fatal dehydration. Simultaneously, enteral nutrition should be gradually introduced, with the final goal of using only enteral nutrition support and/or oral intake and eliminating TPN from the diet. A patient should be considered for discharge when macro and micronutrients can be adequately supplied through enteral nutrition support or oral diet. Currently, there is more research on pediatric patients with SBS than on adult patient population. A 35-year-old man with no notable medical history was hospitalized and underwent a surgery for acute appendicitis at a local hospital. He was re-operated on the 8th day after the initial surgery due to complications and was under observation when he suddenly complained of severe abdominal pain and high fever. He was immediately transferred to a tertiary hospital where the medical team discovered free air in the abdomen. He was subsequently diagnosed with panperitonitis and underwent an emergency reoperation to explore the abdomen. Although the patient was expected to be at a high risk of malnutrition due to short bowel syndrome resulting from multiple surgeries, through intensive care under close cooperation between the medical and nutrition support team, his nutritional status improved significantly through continuous central and peripheral parenteral nutrition, enteral nutrition, and oral intake. The purpose of this paper is to report the process of the patient's recovery.

Keyword

Short bowel syndrome; Nutritional support; Enteral nutrition; Parenteral nutrition

MeSH Terms

Abdomen
Abdominal Pain
Adult
Appendicitis
Dehydration
Diet
Emergencies
Enteral Nutrition
Fever
Humans
Critical Care
Intestine, Small
Malnutrition
Micronutrients
Mortality
Nutritional Status
Nutritional Support*
Parenteral Nutrition
Parenteral Nutrition, Total
Postoperative Care
Reoperation
Short Bowel Syndrome*
Tertiary Care Centers
Micronutrients

Figure

• 

  Figure 1 Progression of nutritional support of the patient.

Reference

1. Nightingale J, Woodward JM. Small Bowel and Nutrition Committee of the British Society of Gastroenterology. Guidelines for management of patients with a short bowel. Gut. 2006; 55:Suppl 4. iv1–i12.

2. Thompson JS, Weseman R, Rochling FA, Mercer DF. Current management of the short bowel syndrome. Surg Clin North Am. 2011; 91:493–510.

3. Compher C, Winkler M, Boullata JI. Nutritional management of short bowel syndrome. In : Marian M, Russell MK, Shikora SA, editors. Clinical nutrition for surgical patients. Sudbury (MA): Jones and Bartlett Publishers;2008. p. 283–306.

4. Matarese LE. Nutrition and fluid optimization for patients with short bowel syndrome. JPEN J Parenter Enteral Nutr. 2013; 37:161–170.

5. DiBaise JK, Young RJ, Vanderhoof JA. Intestinal rehabilitation and the short bowel syndrome: part 2. Am J Gastroenterol. 2004; 99:1823–1832.

6. Levy E, Frileux P, Sandrucci S, Ollivier JM, Masini JP, Cosnes J, Hannoun L, Parc R. Continuous enteral nutrition during the early adaptive stage of the short bowel syndrome. Br J Surg. 1988; 75:549–553.

7. McIntyre PB, Fitchew M, Lennard-Jones JE. Patients with a high jejunostomy do not need a special diet. Gastroenterology. 1986; 91:25–33.

8. Healey KL, Bines JE, Thomas SL, Wilson G, Taylor RG, Sourial M, Pereira-Fantini PM. Morphological and functional changes in the colon after massive small bowel resection. J Pediatr Surg. 2010; 45:1581–1590.

9. Sundaram A, Koutkia P, Apovian CM. Nutritional management of short bowel syndrome in adults. J Clin Gastroenterol. 2002; 34:207–220.

10. Iglesias AC, Portari PE, Zucoloto S, Vannucchi H. Experimental short-bowel syndrome: free amino acid versus intact protein in nutritional support. Nutr Res. 1994; 14:1831–1839.

11. Hua Z, Turner JM, Mager DR, Sigalet DL, Wizzard PR, Nation PN, Ball RO, Pencharz PB, Wales PW. Effects of polymeric formula vs elemental formula in neonatal piglets with short bowel syndrome. JPEN J Parenter Enteral Nut. 2013; Forthcoming.

12. Meier R, Beglinger C, Schneider H, Rowedder A, Gyr K. Effect of a liquid diet with and without soluble fiber supplementation on intestinal transit and cholecystokinin release in volunteers. JPEN J Parenter Enteral Nutr. 1993; 17:231–235.

13. Cummings JH, Southgate DA, Branch WJ, Wiggins HS, Houston H, Jenkins DJ, Jivraj T, Hill MJ. The digestion of pectin in the human gut and its effect on calcium absorption and large bowel function. Br J Nutr. 1979; 41:477–485.

14. Atia A, Girard-Pipau F, Hébuterne X, Spies WG, Guardiola A, Ahn CW, Fryer J, Xue F, Rammohan M, Sumague M, Englyst K, Buchman AL. Macronutrient absorption characteristics in humans with short bowel syndrome and jejunocolonic anastomosis: starch is the most important carbohydrate substrate, although pectin supplementation may modestly enhance short chain fatty acid production and fluid absorption. JPEN J Parenter Enteral Nutr. 2011; 35:229–240.

15. Cole CR, Kocoshis SA. Nutrition management of infants with surgical short bowel syndrome and intestinal failure. Nutr Clin Pract. 2013; Forthcoming.