1/6. Liquid pancreatic enzyme therapy for a patient with short bowel syndrome and chronic pancreatitis in a complicated case of Crohn's disease.The case of a 45 year old female with multiple complications of Crohn's disease is reported. After multiple resections in the gastrointestinal tract she had been suffering from short bowel syndrome and severe malnutrition. With a special continuous gastric tube feeding system, she was able to maintain her weight for years. In the beginning of 1997 the enteral nutrition was not longer tolerated for an exacerbation of chronic pancreatitis. There was a weight loss, permanent pain and total parenteral nutrition had to be performed. In this situation a new liquid preparation of pancreatic enzymes which had been tested in the laboratory before, was used for continuous enzyme replacement via gastric tube. In combination with this enzyme preparation, enteral nutrition could successfully be started again.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
2/6. Diffuse small bowel Crohn's disease treated with side-to-side isoperistaltic strictureplasty: report of two cases and description of a variation of the original technique.Diffuse small bowel Crohn's disease is unusual and it is characterized by multiple diseased segments involving the jejunum and ileum. The most frequent indication for surgery is an intestinal obstruction, often complicated by a high grade of malnutrition. The natural history of this clinical form is not well defined and the optimal surgical approach remains controversial. We herein present our surgical policy in two cases of diffuse small bowel Crohn's disease, who were particularly at risk of developing short bowel syndrome. We focused our attention on the use of side-to-side isoperistaltic strictureplasty as described by Michelassi for the treatment of stenoses longer than 20 cm. We also propose the application of this technique for the treatment of shorter stenosis cases.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
3/6. Living-related bowel transplantation to treat short bowel syndrome in a four-year-old child: a case report.PURPOSE: short bowel syndrome (SBS) is an extremely challenging clinical problem in children. Although many patients can be maintained for a period of time on total parenteral nutrition (TPN), many of these children suffer from the morbidity and mortality associated with sequential central line infections, venous thromboses, and TPN-induced liver failure. Intestinal transplantation often is the only chance for long-term survival. Unfortunately, many children die every year waiting for size-matched cadaveric intestine to become available. methods: After our success with living-related bowel transplantation in adults, the authors successfully transplanted 150 cm of maternal ileum into a 4-year-old 10-kg child with profound malnutrition from SBS and advanced TPN-induced liver failure. Because of the size mismatch, the abdominal cavity could not be closed primarily. The defect was covered with absorbable mesh and subsequently with skin graft. RESULTS: The patient is home with excellent bowel and liver function, off hyperalimentation, and on a regular diet. No rejection has been encountered. CONCLUSIONS: Living-related intestinal transplantation is a life-saving alternative to cadaveric intestinal transplantation in children with short bowel syndrome.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
4/6. A therapeutic approach to wean total parenteral nutrition in the management of short bowel syndrome: three cases using nocturnal enteral rehydration.short bowel syndrome is characterized by severe dehydration and malnutrition and requires total parenteral nutrition (TPN). Prolonged TPN has serious complications. Caloric requirements can be met orally but oral fluid replacement is problematic. Noncompliance and an inability to discontinue TPN earlier increase the likelihood of complications. Discontinuation of parenteral support requires an assessment of gastrointestinal anatomy and absorption capacity. Fluids must be replaced independently of feedings because the osmotic gradients decrease fluid absorption. Nocturnal enteral rehydration is an intervention using oral rehydration solutions through percutaneous endoscopic gastrostomy tubes at night. patients given nocturnal enteral rehydration discontinued TPN earlier and had improved fluid absorption.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
5/6. Practical guide to intestinal rehabilitation for postresection intestinal failure: a case study.After massive small-intestinal resection or combined small-intestinal and colonic resection, diarrhea with resulting dehydration, electrolyte abnormalities, and malnutrition occur. Many patients become dependent on IV fluids and nutrition. An adaptation process manifested clinically by decreased diarrhea and improved nutrient absorption according to decreased parenteral nutrition and fluid requirements has been noted to occur over time. In some patients, adaptation is inadequate and may require special techniques to enhance and augment this process. This is a case of a 52-year-old woman who experienced increased stoma output 1 week after major intestinal resection, resulting in dehydration. She required IV fluids in order to maintain hydration. After the initiation of an intestinal rehabilitation program, which included modified diet, soluble fiber, oral rehydration solution (ORS), and medications, IV fluids were successfully weaned off in 3 months. She continues not to receive IV fluids and continues to follow the intestinal rehabilitation plan.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
6/6. TPN-induced catch-up of growth in a 22-y-old male with radiation enteritis.Nutritional rehabilitation of malnourished children with growth arrest is generally associated with a catch-up of growth but the occurrence of this compensatory phenomenon in adulthood is not well recognized. We investigated a case of maturation and growth acceleration secondary to nutritional intervention in a 22-y-old patient. After treatment for a rhabdomyosarcoma of the bladder at age 7 y, the patient developed severe malabsorption secondary to radiation enteritis and short bowel syndrome. As a result of profound malnutrition, growth and maturation were severely impaired. Initiation of home total parenteral nutrition at age 22 y led to an increase in height, substantial weight gain, advancement of bone age, and sexual maturation evidenced by appearance of secondary sex characteristics and normalization of hormone concentrations. The development of signs of puberty and a growth spurt appearing at this late age clearly show the potential for maturation and growth once malnutrition is corrected.- - - - - - - - - - ranking = 2keywords = malnutrition (Clic here for more details about this article) |