Abstract
The serial transverse enteroplasty (STEP) procedure is a safe and successful way to lengthen the small bowel in patients with short bowel syndrome. However, postoperative dilatation of the intestine may occur, which induces bacterial overgrowth and malabsorption leading to liver failure. We describe the case of an infant boy with short bowel syndrome caused by jejunal atresia requiring the STEP procedure twice. The first STEP improved the liver function, and the second STEP allowed 80% of the total calorie intake to be tolerated enterally. One should not hesitate to perform a second STEP if after the initial bowel lengthening procedure the patient develops small bowel dilatation that interferes with enteral nutrition.
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References
Duro D, Kamin D, Duggan C (2008) Overview of pediatric short bowel syndrome. J Pediatr Gastroenterol Nutr 47(Suppl 1):S33–S36
Spencer AU, Neaga A, West B, Safran J, Brown P, Btaiche I, Kuzma-O’Reilly B, Teitelbaum DH (2005) Pediatric short bowel syndrome: redefining predictors of success. Ann Surg 242(3):403–412
Bianchi A (1980) Intestinal loop lengthening—a technique for increasing small intestinal length. J Pediatr Surg 15(2):145–151
Bianchi A (2006) From the cradle to enteral autonomy: the role of autologous gastrointestinal reconstruction. Gastroenterology 130(2 Suppl 1):S138–S146
Walker SR, Nucci A, Yaworski JA, Barksdale EM Jr (2006) The Bianchi procedure: a 20-year single institution experience. J Pediatr Surg 41(1):113–119
Bianchi A (1997) Longitudinal intestinal lengthening and tailoring: results in 20 children. J R Soc Med 90(8):429–432
Bueno J, Guiterrez J, Mazariegos GV, Abu-Elmagd K, Madariaga J, Ohwada S, Kocoshis S, Reyes J (2001) Analysis of patients with longitudinal intestinal lengthening procedure referred for intestinal transplantation. J Pediatr Surg 36(1):178–183
Kim HB, Fauza D, Garza J, Oh JT, Nurko S, Jaksic T (2003) Serial transverse enteroplasty (STEP): a novel bowel lengthening procedure. J Pediatr Surg 38(3):425–429
Kim HB, Lee PW, Garza J, Duggan C, Fauza D, Jaksic T (2003) Serial transverse enteroplasty for short bowel syndrome: a case report. J Pediatr Surg 38(6):881–885
Chang RW, Javid PJ, Oh JT, Andreoli S, Kim HB, Fauza D, Jaksic T (2006) Serial transverse enteroplasty enhances intestinal function in a model of short bowel syndrome. Ann Surg 243(2):223–228
Javid PJ, Kim HB, Duggan CP, Jaksic T (2005) Serial transverse enteroplasty is associated with successful short-term outcomes in infants with short bowel syndrome. J Pediatr Surg 40(6):1019–1023
Modi BP, Javid PJ, Jaksic T, Piper H, Langer M, Duggan C, Kamin D, Kim HB, International STEP Data Registry (2007) First report of the international serial transverse enteroplasty data registry: indications, efficacy, and complications. J Am Coll Surg 204(3):365–371
Wales PW, de Silva N, Langer JC, Fecteau A (2007) Intermediate outcomes after serial transverse enteroplasty in children with short bowel syndrome. J Pediatr Surg 42(11):1804–1810
Waag KL, Hosie S, Wessel L (1999) What do children look like after longitudinal intestinal lengthening? Eur J Pediatr Surg 9(4):260–262
Morikawa N, Suematsu M, Kyokane T, Goda N, Kumamoto Y, Okitsu T, Ishimura Y, Kitajima M (1998) Discontinuous total parenteral nutrition prevents postischemic mitochondrial dysfunction in rat liver. Hepatology 28(5):1289–1299
Shiomi M, Wakabayashi Y, Sano T, Shinoda Y, Nimura Y, Ishimura Y, Suematsu M (1998) Nitric oxide suppression reversibly attenuates mitochondrial dysfunction and cholestasis in endotoxemic rat liver. Hepatology 27(1):108–115
Ehrlich PF, Mychaliska GB, Teitelbaum DH (2007) The 2 STEP: an approach to repeating a serial transverse enteroplasty. J Pediatr Surg 42(5):819–822
Piper H, Modi BP, Kim HB, Fauza D, Glickman J, Jaksic T (2006) The second STEP: the feasibility of repeat serial transverse enteroplasty. J Pediatr Surg 41(12):1951–1956
Andres AM, Thompson J, Grant W, Botha J, Sunderman B, Antonson D, Langnas A, Sudan D (2008) Repeat surgical bowel lengthening with the STEP procedure. Transplantation 85(9):1294–1299
Modi BP, Ching YA, Langer M, Donovan K, Fauza DO, Kim HB, Jaksic T, Nurko S (2009) Preservation of intestinal motility after the serial transverse enteroplasty procedure in a large animal model of short bowel syndrome. J Pediatr Surg 44(1):229–235
Acknowledgments
The authors thank Paul D. Danielson MD, for reading the manuscript and helpful discussions and Heung B. Kim MD, for thoughtful suggestions regarding the operative technique and indication.
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There is no potential conflict of interest, and neither grants nor other form of payments were given to any authors.
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Morikawa, N., Kuroda, T., Kitano, Y. et al. Repeat STEP procedure to establish enteral nutrition in an infant with short bowel syndrome. Pediatr Surg Int 25, 1007–1011 (2009). https://doi.org/10.1007/s00383-009-2456-1
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DOI: https://doi.org/10.1007/s00383-009-2456-1