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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 5/2015

01-05-2015 | Case Report

No Gut Syndrome: Near Total Enterectomy

Authors: Sergio Huerta, Sachin Kukreja, Kristen Carter, Dale Butler

Published in: Journal of Gastrointestinal Surgery | Issue 5/2015

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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.
Literature
1.
Sise, M. J. Acute mesenteric ischemia. Surg Clin. North Am 94:165–181, 2014.
2.
Tappenden, K. A. Pathophysiology of short bowel syndrome: considerations of resected and residual anatomy. JPEN J. Parenter. Enteral Nutr. 38:14S-22S, 2014.
3.
Ladefoged, K. Quality of life in patients on permanent home parenteral nutrition. JPEN J Parenter. Enteral Nutr. 5:132–137, 1981.
4.
KINNEY, J. M., GOLDWYN, R. M., BARR, J. S., Jr., and MOORE, F. D. Loss of the entire jejunum and ileum, and the ascending colon. Management of a patient. JAMA 179:529–532, 1962.
5.
Langer, B., McHattie, J. D., Zohrab, W. J., and Jeejeebhoy, K. N. Prolonged survival after complete small bowel resection using intravenous alimentation at home. J Surg Res 15:226–233, 1973.
6.
Shils, M. E., Wright, W. L., Turnbull, A., and Brescia, F. Long-term parenteral nutrition through an external arteriovenous shunt. N. Engl. J Med. 283:341–344, 1970.
7.
Williams, I. M., Scriven, M. W., Burgess, N. A., Davies, C. J., and Lewis, M. H. Survival after resection and duodenocolostomy for massive mesenteric infarction after aortic surgery. Ann. R. Coll. Surg Engl. 78:69–70, 1996.
8.
MARIEN, B., and McCORRISTON, J. R. Effects of resection of massive segments of large and small bowel upon fluid and electrolyte balance: an experimental and clinical study. Surg Forum 123-129, 1953.
9.
WILKIE, W. Massive resection of small gut, report of a case. S. Afr. Med. J 24:516–520, 1950.
10.
ALTHAUSEN, T. L., UYEYAMA, K., and SIMPSON, R. G. Digestion and absorption after massive resection of the small intestine; utilization of food from a natural versus a synthetic diet and a comparison of intestinal absorption tests with nutritional balance studies in a patient with only 45 cm. of small intestine. Gastroenterology 12:795–807, 1949.
11.
JORDAN, P. H., Jr., STUART, J. R., and BRIGGS, J. D. Radical small-bowel resection; report of two cases. Am J Dig. Dis. 3:823–843, 1958.
12.
Simons, B. E., and Jordan, G. L., Jr. Massive bowel resection. Am J Surg. 118:953–959, 1969.
13.
Martin, J. R., Pattee, C. J., Gardner, C., and Marien, B. Massive resection of the small intestine. Can. Med. Assoc. J. 69:429–433, 1953.
14.
DOOLAN, P. D., KYLE, L. H., HESS, W., and PHELPS, E. Gastrocolostomy: clinical observations and experimental studies. Gastroenterology 18:566–578, 1951.
15.
JOHNSTON, J. R., and REAGAN, L. B. Short-term survival following massive small bowel resection: case report. Surgery 32:858–862, 1952.
16.
Craig, R. M., Neumann, T., Jeejeebhoy, K. N., and Yokoo, H. Severe hepatocellular reaction resembling alcoholic hepatitis with cirrhosis after massive small bowel resection and prolonged total parenteral nutrition. Gastroenterology 79:131–137, 1980.
17.
Bordos, D. C., and Cameron, J. L. Successful long-term intravenous hyperalimentation in the hospital and at home. Arch. Surg 110:439–441, 1975.
18.
Espinoza, F. T., and Stephenson, R. H. Long-term survival after massive bowel infarction. Am J Gastroenterol. 54:247–252, 1970.
19.
Walker-Smith, J. Total loss of mid-gut. Med. J Aust. 1:857–860, 1967.
20.
Stanko, R. T., Nathan, G., Mendelow, H., and Adibi, S. A. Development of hepatic cholestasis and fibrosis in patients with massive loss of intestine supported by prolonged parenteral nutrition. Gastroenterology 92:197–202, 1987.
21.
Ito, Y., and Shils, M. E. Liver dysfunction associated with long-term total parenteral nutrition in patients with massive bowel resection. JPEN J Parenter. Enteral Nutr. 15:271–276, 1991.
22.
Thomas, A. D., Rocker, M. D., Morris-Stiff, G., and Lewis, M. H. Gastro-colonic anastomosis—a viable option in extensive small bowel infarction. Ann. R. Coll. Surg Engl. 88:26, 2006.
23.
Pironi, L., Joly, F., Forbes, A., Colomb, V., Lyszkowska, M., Baxter, J., Gabe, S., Hebuterne, X., Gambarara, M., Gottrand, F., Cuerda, C., Thul, P., Messing, B., Goulet, O., Staun, M., and Van, G. A. Long-term follow-up of patients on home parenteral nutrition in Europe: implications for intestinal transplantation. Gut 60:17–25, 2011.
24.
Sudan, D. The current state of intestine transplantation: indications, techniques, outcomes and challenges. Am J Transplant. 14:1976–1984, 2014.
25.
Lloyd, D. A., Vega, R., Bassett, P., Forbes, A., and Gabe, S. M. Survival and dependence on home parenteral nutrition: experience over a 25-year period in a UK referral centre. Aliment. Pharmacol. Ther. 24:1231–1240, 2006.
26.
Howard, L., Heaphey, L., Fleming, C. R., Lininger, L., and Steiger, E. Four years of North American registry home parenteral nutrition outcome data and their implications for patient management. JPEN J Parenter. Enteral Nutr. 15:384–393, 1991.
27.
Jeppesen, P. B., Staun, M., and Mortensen, P. B. Adult patients receiving home parenteral nutrition in Denmark from 1991 to 1996: who will benefit from intestinal transplantation? Scand. J Gastroenterol. 33:839–846, 1998.
28.
Pironi, L., Paganelli, F., Labate, A. M., Merli, C., Guidetti, C., Spinucci, G., and Miglioli, M. Safety and efficacy of home parenteral nutrition for chronic intestinal failure: a 16-year experience at a single centre. Dig. Liver Dis. 35:314–324, 2003.
29.
Vantini, I., Benini, L., Bonfante, F., Talamini, G., Sembenini, C., Chiarioni, G., Maragnolli, O., Benini, F., and Capra, F. Survival rate and prognostic factors in patients with intestinal failure. Dig. Liver Dis. 36:46–55, 2004.
30.
Buchman, A. L., Scolapio, J., and Fryer, J. AGA technical review on short bowel syndrome and intestinal transplantation. Gastroenterology 124:1111–1134, 2003.
31.
Howard, L., and Ashley, C. Management of complications in patients receiving home parenteral nutrition. Gastroenterology 124:1651–1661, 2003.
32.
Richards, D. M., Deeks, J. J., Sheldon, T. A., and Shaffer, J. L. Home parenteral nutrition: a systematic review. Health Technol. Assess. 1:1-59, 1997.
33.
Chan, S., McCowen, K. C., Bistrian, B. R., Thibault, A., Keane-Ellison, M., Forse, R. A., Babineau, T., and Burke, P. Incidence, prognosis, and etiology of end-stage liver disease in patients receiving home total parenteral nutrition. Surgery 126:28–34, 1999.
34.
Baxter, J. P., Fayers, P. M., and McKinlay, A. W. A review of the quality of life of adult patients treated with long-term parenteral nutrition. Clin. Nutr. 25:543–553, 2006.
35.
Howard, L. Home parenteral nutrition: survival, cost, and quality of life. Gastroenterology 130:S52-S59, 2006.
36.
Smith, C. E., Curtas, S., Werkowitch, M., Kleinbeck, S. V., and Howard, L. Home parenteral nutrition: does affiliation with a national support and educational organization improve patient outcomes? JPEN J Parenter. Enteral Nutr. 26:159–163, 2002.
37.
DiMartini, A., Rovera, G. M., Graham, T. O., Furukawa, H., Todo, S., Funovits, M., Lu, S., and Abu-Elmagd, K. Quality of life after small intestinal transplantation and among home parenteral nutrition patients. JPEN J Parenter. Enteral Nutr. 22:357–362, 1998.
38.
Rovera, G. M., DiMartini, A., Schoen, R. E., Rakela, J., Abu-Elmagd, K., and Graham, T. O. Quality of life of patients after intestinal transplantation. Transplantation 66:1141–1145, 1998.
39.
Abu-Elmagd, K. M., Kosmach-Park, B., Costa, G., Zenati, M., Martin, L., Koritsky, D. A., Emerling, M., Murase, N., Bond, G. J., Soltys, K., Sogawa, H., Lunz, J., Al, S. M., Shaefer, N., Sindhi, R., and Mazariegos, G. V. Long-term survival, nutritional autonomy, and quality of life after intestinal and multivisceral transplantation. Ann. Surg 256:494–508, 2012.
40.
Pironi, L., Baxter, J. P., Lauro, A., Guidetti, M., Agostini, F., Zanfi, C., and Pinna, A. D. Assessment of quality of life on home parenteral nutrition and after intestinal transplantation using treatment-specific questionnaires. Am J Transplant. 12 Suppl 4:S60-S66, 2012.
41.
Messing, B., Crenn, P., Beau, P., Boutron-Ruault, M. C., Rambaud, J. C., and Matuchansky, C. Long-term survival and parenteral nutrition dependence in adult patients with the short bowel syndrome. Gastroenterology 117:1043–1050, 1999.
Metadata
Title
No Gut Syndrome: Near Total Enterectomy
Authors
Sergio Huerta
Sachin Kukreja
Kristen Carter
Dale Butler
Publication date
01-05-2015
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 5/2015
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-015-2787-2

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