Eleven years of management of children with intestinal failure and not candidates for intestinal transplantation

Spagnuolo, M.I.; Cicalese, M.P.; Bruzzese, Eugenia; Caiazzo, M.A.; Di, Simona; Squeglia, Veronica; Guarino, Alfredo

doi:10.2147/trrm.s11930

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“…Aufgrund der rasanten Verbesserungen in der Behandlung der transplantationsbedingten Reaktionen wird die 5-Jahres-Überlebensrate für Kinder bei einer kombinierten Leber-Darm-Transplantation mit 81 % und bei einer isolierten Dünndarmtransplantation mit 56% angegeben[65]. Die Indikationsstellung zur Transplantation sollte einem individuellen multidisziplinären Konsens entspringen, da die Überlebensraten auch kritisch gesehen werden[66] und weitere Faktoren zu berücksichtigen sind[67]. Die Überlegung, einen Teil des Dünndarms antiperistaltisch zu platzieren und somit eine Passageverzögerung und Erhöhung der Resorptionsleistung zu erzielen, ist einleuchtend.…”

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Altersabhängige Viszeralmedizin: pädiatrische Viszeralmedizin - viszeralmedizinische Pädiatrie - Überlegungen zum Kurzdarmsyndrom im Kindesalter

et al. 2012

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There are several reasons for the possible development of a short bowel syndrome, which, however, occurs only rarely. The main causes consist of extended intestinal resections in cases of congenital anomalies (e.g., gastroschisis, intestinal atresia or dysplasia) or ischaemic lesions due to a volvulus. In addition, an intestinal stoma at a more upper segment of the GI tract can result in the functional manifestation of a short bowel syndrome. The differentiation between temporary and persisting types is essential for initiation of an adequate treatment. Loss or exclusion of organic resorption area at the inner surface of the (small) intestine can be associated with numerous pathological consequences requiring treatment. As a principle consideration from the paediatric point of view, the potential of intestinal adaptation needs to be assessed. Basic conservative treatment options are parenteral and enteral nutrition regimens, in particular, to prevent complications (such as D-lactate acidosis). The main surgical approaches are the procedures called LILT (longitudinal intestinal lengthening and tailoring) according to Bianchi and STEP (serial transverse enteroplasty). The technique to create intestinal segments of antiperistalsis has been abandoned. Because of the encouraging results of intestinal transplantation, this novel treatment option has gained greater attention over the past few years and is now also an option for paediatric patients. The limiting factor and thus major complication is the central venous catheter for long-term treatment. Catheter-related complications are still the main reason for a considerable mortality in these children.

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