Massive enterectomy: Indications and management

Abstract

Massive enterectomy in adults may be necessary for Crohn's disease in young patients or for intestinal infarction in older patients. Other indications are rare. When less than 3 m of small bowel remain, a number of serious metabolic and nutritional abnormalities occur. When 2 m or less remain, most patients have a limited work capacity as weli, and many patients with less than 1 m of small bowel need parenteral nutrition at home on an indefinite basis. Correct management depends on an understanding of the disordered physiological state brought about by the resection and a realization that adaptation may occur. Based on these principles, the management of these patients in the operating room and during their subsequent rehabilitation is discussed.

Energy absorption as a measure of intestinal failure in the short bowel syndrome.

“…Furthermore, measurement of intestinal length at surgery may be subject to error for technical reasons and also because length depends on contraction of longitudinal muscle during a single operative procedure. 4 A functional measure of absorptive capacity would circumvent these difficulties and could identify those patients likely to need longterm parenteral nutrition. Moreover, if such a test were simple and noninvasive, it could be repeated at intervals, thus providing a clinically useful measure of intestinal adaptation.…”

Intestinal Resection in Adults: Causes and Consequences

“…This con dition most frequently resulted from massive intestinal resection (75%) but was caused by sequential, lesser resections in 25% of patients. Although Crohn's disease requiring intestinal resection has been reported to be the most common cause of the short bowel syndrome in other studies, none of our patients with Crohn's disease were so affected [6,7], This may reflect a more conserva tive approach to operation in this disease and the use of techniques to preserve intestinal length [8],…”

The effects of oral liquid and intravenous glutamine on bowel adaptation in a rabbit short bowel syndrome model

“…In this adaptation process, the most important factors that increase cellular growth are luminal factors and hormones (2,3). After resection, the relation between food and endogenous growth factors is important in understanding the essential mechanisms behind the mucosal growth during intestinal adaptation (4,5). In elderly patients, the intestinal adaptation is impaired and not as efficient.…”

“…The enteroglucagons ejected from the terminal ileum and colon, epidermal growth factor (EGF), transforming growth factor-a, peptide YY, insulin-like growth factor (IGF) I-II, prostaglandins, corticosteroids, cholecystokinin, secretin, and similar factors play roles in intestinal growth and in the adaptation of the functions after intestinal resection (6-9, 10, 30). They are thought to have a stimulant effect on the adaptation by increasing endogenous ejections of foods (4,5). It is also known that foods taken orally cause hyperplasia and hyper-function in the intestinal mucosa.…”