Short Bowel Syndrome: Life–Saving Parenteral Nutrition for 4 Months: A Clinical Case

Abstract

Background: Short bowel syndrome (SBS) in adults is defined as having less than 180 to 200 cm of remaining small bowel. The most common pathologies leading to SBS include Crohn disease, mesenteric ischemia, radiation enteritis, post-surgical adhesions, and post-operative complications. In advanced SBS, parenteral nutrition may be required to ensure that all vital nutrients are delivered directly through the venous system. Objectives: To investigate a clinical case of a patient who underwent parenteral nutrition for four months due to SBS. Methods: A despersonalised medical records were analyzed. Results: A 76-year-old patient, with a previous history of abdominal surgery, was presented with abdominal pain, nausea, vomiting. Initial investigations revealed a complete intestinal obstruction. Surgery was performed, including adhesiolysis, drainage and a release of a strangulated loop and stitching. However, post-surgery, persistent abdominal pain continued for 9 days until a CT scan revealed stercoral peritonitis. This prompted an urgent relaparotomy, which involved the removal of 20 cm of necrotic and perforated small bowel, peritoneal lavage, drainage, and the creation of a two-tube jejunostomy, leaving 60 cm of small bowel from the ligament of Treitz. Full parenteral nutrition (FPN) began about a week after the second surgery due to SBS, lasting for a total of 4 months. Once hypoproteinaemia and hypoalbuminaemia were corrected (increasing from 63.0 g/l to 65.5 g/l and from 27.0 g/l to 32.8 g/l, respectively), an open bowel surgery was performed, involving laparotomy and ileostomy closure. After the restoration of intestinal integrity and returning to a normal diet the patient was referred for outpatient care. Discussion & Conclusion: In cases of malnutrition where oral or enteral feeding is impossible or contraindicated, the use of temporary or permanent parenteral nutrition can prove to be a life-saving intervention. After successfully restoring nutritional status and discontinuing artificial feeding, and in the absence of intestinal insufficiency, the most effective surgical method to restore intestinal integrity is through small and large bowel re-anastomosis. For patients for whom this surgery is not a viable option, parenteral nutrition remains the sole path that leads to a more favorable outcome and ensures the preservation of their quality of life.