One of the first reported massive bowel resection was in 1880 when Koeberle described the resection of more than 200 cm of small bowel in a patient that in the end survived (Koeberle E. Bull Acad Med 8:249–50, 1881). In the late 1960s, parenteral nutrition (PN) became available having a tremendous impact in the management and outcome of patients with short bowel syndrome (SBS). Once PN support was better developed in the 1970s, the field moved toward delivering PN at home. Soon, hospitals developed home PN programs to decrease expenses and allow patients to return home.
Over the past decade, lengthening procedures (Kim et al. J Pediatr Surg 38(3):425–429, 2003; Sudan et al. Ann Surg 246(4):593–601, 2007; Mercer et al. J Pediatr 164(1):93–98, 2014), techniques to decrease central venous catheter (CVC)-related sepsis such as ethanol lock (Cober et al. JPEN J Parenter Enteral Nutr 35(1):67–73, 2011), and the use of different lipid emulsions like omega-3 fatty acids (Diamond et al. J Pediatr Gastroenterol Nutr 48(2):209–215, 2009) and lipid minimization strategies (El Kasmi et al. Sci Transl Med 5(206):137–160, 2013) have emerged as modalities that have impacted the overall outcome of intestinal failure and long-term PN use.
All this has led to more comprehensive programs to manage children with intestinal failure known as intestinal rehabilitation programs. These programs usually have different professional disciplines, such as pediatric gastroenterologists, surgeons, dietitians, nurses, social workers, psychologist, feeding therapists, etc., organized as a multidisciplinary team to address the complexity of these children. These intestinal rehabilitation programs have had a major impact in overall outcome, more so, over the past decade. I discussed general concepts that would lead to a successful and modern intestinal rehabilitation program.
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
Central venous catheter
Small bowel bacterial overgrowth
Small bowel length
Short bowel syndrome
Serial transverse enteroplasty
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Koeberle E. Resection de deux metres d’intestine grele guerison. Bull Acad Med. 1881;8:249–50.Google Scholar
Kim HB, Fauza D, Garza J, Oh JT, Nurko S, Jaksic T. Serial transverse enteroplasty (STEP): a novel bowel lengthening procedure. J Pediatr Surg. 2003;38(3):425–9.CrossRefPubMedGoogle Scholar
Sudan D, Thompson J, Botha J, Grant W, Antonson D, Raynor S, Langnas A. Comparison of intestinal lengthening procedures for patients with short bowel syndrome. Ann Surg. 2007;246(4):593–601.CrossRefPubMedGoogle Scholar
Mercer DF, Hobson BD, Gerhardt BK, Grant WJ, Vargas LM, Langnas AN, Quiros-Tejeira RE. Serial transverse enteroplasty allows children with short bowel to wean from parenteral nutrition. J Pediatr. 2014;164(1):93–8.CrossRefPubMedGoogle Scholar
Cober MP, Kovacevich DS, Teitelbaum DH. Ethanol-lock therapy for the prevention of central venous access device infections in pediatric patients with intestinal failure. JPEN J Parenter Enteral Nutr. 2011;35(1):67–73.CrossRefPubMedGoogle Scholar
Diamond IR, Sterescu A, Pencharz PB, Kim JH, Wales PW. Changing the paradigm: omegaven for the treatment of liver failure in pediatric short bowel syndrome. J Pediatr Gastroenterol Nutr. 2009;48(2):209–15.CrossRefPubMedGoogle Scholar
El Kasmi KC, Anderson AL, Devereaux MW, Vue PM, Zhang W, Setchell KD, Karpen SJ, Sokol RJ. Phytosterols promote liver injury and Kupffer cell activation in parenteral nutrition-associated liver disease. Sci Transl Med. 2013;5(206):137–60.CrossRefGoogle Scholar
Siebert JR. Small-intestine length in infants and children. Am J Dis Child. 1980;134:593–5.PubMedGoogle Scholar
Quirós-Tejeira RE, Ament ME, Reyen L, Herzog F, Merjanian M, Olivares-Serrano N, Vargas JH. Long-term parenteral nutritional support and intestinal adaptation in children with short bowel syndrome: a 25-year experience. J Pediatr. 2004;145(2):157–63.CrossRefPubMedGoogle Scholar
Infantino BJ, Mercer DF, Hobson BD, Fischer RT, Gerhardt BK, Grant WJ, Langnas AN, Quiros-Tejeira RE. Successful rehabilitation in pediatric ultrashort small bowel syndrome. J Pediatr. 2013;163(5):1361–6.CrossRefPubMedGoogle Scholar
Sondheimer JM, Cadnapaphornchai M, Sontag M, Zerbe GO. Predicting the duration of dependence on parenteral nutrition after neonatal intestinal resection. J Pediatr. 1998;132(1):80–4.CrossRefPubMedGoogle Scholar
Andorsky DJ, Lund DP, Lillehei CW, Jaksic T, Dicanzio J, Richardson DS, Collier SB, Lo C, Duggan C. Nutritional and other postoperative management of neonates with short bowel syndrome correlates with clinical outcomes. J Pediatr. 2001;139(1):27–33.CrossRefPubMedGoogle Scholar
Christie DL, Ament ME. Dilute elemental diet and continuous infusion technique for management of short bowel syndrome. J Pediatr. 1975;87:705–8.CrossRefPubMedGoogle Scholar
Vargas JH, Ament ME, Berquist WE. Long-term home parenteral nutrition in pediatrics: ten years of experience in 102 patients. J Pediatr Gastroenterol Nutr. 1987;6(1):24–32.CrossRefPubMedGoogle Scholar
Vanderhoof JA, Park JH, Herrington MK, Adrian TE. Effects of dietary menhaden oil on mucosal adaptation after small bowel resection in rats. Gastroenterology. 1994;106(1):94–9.CrossRefPubMedGoogle Scholar
Taylor SF, Sondheimer JM, Sokol RJ, Silverman A, Wilson HL. Noninfectious colitis associated with short gut syndrome in infants. J Pediatr. 1991;119(1):24–8.CrossRefPubMedGoogle Scholar
Ladd AP, Grosfeld JL, Pescovitz OH, Johnson NB. The effect of growth hormone supplementation on late nutritional independence in pediatric patients with short bowel syndrome. J Pediatr Surg. 2005;40(2):442–5.CrossRefPubMedGoogle Scholar
Jeppesen PB. Clinical significance of GLP-2 in short-bowel syndrome. J Nutr. 2003;133(11):3721–4.PubMedGoogle Scholar
Burrin DG, Stoll B, Jiang R, Petersen Y, Elnif J, Buddington RK, Schmidt M, Holst JJ, Hartmann B, Sangild PT. GLP-2 stimulates intestinal growth in premature TPN-fed pigs by suppressing proteolysis and apoptosis. Am J Physiol Gastrointest Liver Physiol. 2000;279(6):G1249–56.PubMedGoogle Scholar
Miazza BM, Al-Mukhtar MY, Salmeron M, Ghatei MA, Felce-Dachez M, Filali A, Villet R, Wright NA, Bloom SR, Crambaud JC. Hyperenteroglucagonaemia and small intestinal mucosal growth after colonic perfusion of glucose in rats. Gut. 1985;26:518–24.CrossRefPubMedPubMedCentralGoogle Scholar
Bianchi A. Intestinal loop lengthening--a technique for increasing small intestinal length. J Pediatr Surg. 1980;15(2):145–51.CrossRefPubMedGoogle Scholar
Kaufman SS, Loseke CA, Lupo JV, Young RJ, Murray ND, Pinch LW, Vanderhoof JA. Influence of bacterial overgrowth and intestinal inflammation on duration of parenteral nutrition in children with short bowel syndrome. J Pediatr. 1997;131(3):356–61.CrossRefPubMedGoogle Scholar
Sukhotnik I, Yakirevich E, Coran AG, Siplovich L, Krausz M, Sabo E, Kramer A, Shiloni E. Lipopolysaccharide endotoxemia reduces cell proliferation and decreases enterocyte apopotosis during intestinal adaptation in a rat model of short-bowel syndrome. Pediatr Surg Int. 2002;18(7):615–9.CrossRefPubMedGoogle Scholar
Ellegard L, Sunesson A, Bosaeus I. High serum phytosterol levels in short bowel patients on parenteral nutrition support. Clin Nutr. 2005;24(3):415–20.CrossRefPubMedGoogle Scholar
Kowlgi NG, Chhabra L. D-lactic acidosis: an underrecognized complication of short bowel syndrome. Gastroenterol Res Pract. 2015:476215. Published online 2015 Apr 22.Google Scholar
Stolberg L, Rolfe R, Gitlin N, Merritt J, Mann Jr L, Linder J, Finegold S. D-Lactic acidosis due to abnormal gut flora: diagnosis and treatment of two cases. N Engl J Med. 1982;306(22):1344–8.CrossRefPubMedGoogle Scholar
Bongaerts G, Bakkeren J, Severijnen R, Sperl W, Willems H, Naber T, Wevers R, van Meurs A, Tolboom J. Lactobacilli and acidosis in children with short small bowel. J Pediatr Gastroenterol Nutr. 2000;30(3):288–93.CrossRefPubMedGoogle Scholar
Couper RT, Durie PR, Stafford SE, Filler RM, Marcon MA, Forstner GG. Late gastrointestinal bleeding and protein loss after distal small-bowel resection in infancy. J Pediatr Gastroenterol Nutr. 1989;9(4):454–60.CrossRefPubMedGoogle Scholar
Wilmore DW. Factors correlating with a successful outcome following extensive intestinal resection in newborn infants. J Pediatr. 1972;80:88–95.CrossRefPubMedGoogle Scholar