Lessons learned from successful autologous gastrointestinal reconstruction in patients with intestinal failure: a case series

Abstract

Background Intestinal failure (IF) is a rare but severe form of organ failure. The condition is defined as body’s inability to absorb adequate fluids, macronutrients and minerals for growth and development, so that intravenous supplementation is necessary. A broad spectrum of diseases, trauma and complications of surgery might eventually end up with intestinal failure. Nowadays, intestinal failure patients are preferably cared for in intestinal rehabilitation units (IRU). Autologous gastrointestinal reconstruction (AGIR) refers to non-transplant operative management of IF patients designed to improve enteral tolerance and gut absorptive capacity. Case presentation Herein we present five cases with complications of surgeries due to peptic ulcer bleeding, blunt abdominal trauma, obesity and gastric tumor. The surgeries were complicated by anastomotic leak, peritonitis and fistula formation. By adopting multidisciplinary decisions and special care for each complication, all the five patients were successfully managed and discharged. Discussion and conclusions As presented, re-anastomosis in presence of abdominal contamination will probably fail. In patients with intestinal failure, PN should start as soon as possible to increase the success rate of future surgeries and prevent potential need for intestinal transplantation. We suggest referring patients with complicated outcomes of gastrointestinal surgeries to the IRUs to reduce morbidity and mortality.

Experiences with intestinal failure from an intestinal rehabilitation unit in a country without home parenteral nutrition

“…In cases where possible, the end part of the proximal part of the small bowel (when it is <50 cm), is closed; moreover, for alleviating abdominal compression a gastrojejunostomy is set. This is done to increase the diameter of the small bowel within the proximal region and to prepare the patient for the STEP surgery to establish continuity of the small bowel (Supplement File 1) 9 . In cases where a patient is referred to our center after 10 days from their primary abdominal surgery, surgical interventions are planned based on the anatomy of the small bowel.…”

“…This is done to increase the diameter of the small bowel within the proximal region and to prepare the patient for the STEP surgery to establish continuity of the small bowel (Supplement File 1). 9 In cases where a patient is referred to our center after 10 days from their primary abdominal surgery, surgical interventions are planned based on the anatomy of the small bowel. For example, if a patient has an ostoma set in place during their primary surgery, after 2 months, the ostoma is closed, and in cases where the patient develops leakage after the primary anastomosis, an ostoma is placed for them.…”

Serial transverse enteroplasty and nipple valve construction, two life saving techniques for patients with short bowel syndrome, a report of 5 cases

“…Acutely ill and metabolically unstable IF patients who have survived a complicated abdominal surgery are cared for in intestinal rehabilitation units (IRU) by a multidisciplinary team (MDT) including surgeons, pharmacists, nutritionists and various other specialists [ 9 ]. The MDT designs essential PN and hydration, manages fistulae, open abdomen, PN complications and infections until the patient becomes independent of inpatient PN or is prepared for further abdominal operations including autologous intestinal reconstruction (AGIR) or intestinal transplantation [ 10 – 12 ]. AGIR refers to various surgical techniques to enhance intestinal absorptive mucosa in order to minimize dysmotility and the need for intestinal transplantation [ 13 ].…”