How to live with short bowel syndrome?

Abstract

Introduction: Absorption of nutrients in short bowel syndrome (SBS) is seriously impaired. The adequate treatment of SBS are parenteral and enteral fluid, electrolyte, nutrient and vitamin substitutions. If more than 80 percent of the small bowel is resected, generally life-long total or supplementary parenteral nutrition is required. A 63 year-old male patient with the hystory of ulcerative colitis and mesalazine therapy since 1986 has been treated several times for entamoeba histolytica and dyspar infection. In 2003 the relapse of ulcerative colitis was treated with olsalazine and parenteral methyprednisolon, but on the second day of therapy acute abdomen developed. Laparotomy revealed ileal necrosis. Resection and later reresection was necessary due to progressive ileal necrosis. In 2004 subtotal colectomy, ileostomy with rectal restoration and also ileal segment resection were performed for necrosis. After the surgery only 80cm of small bowel remained. His weight decreased from 79 to 50kg, laboratory tests showed severe malnutrition, electrolyte disorder and frequent tetanic cramps occured. Initially parenteral infusion with calcium, potassium, magnesium and orally Protifar, Fantomal and Ensure were administered. Since 2005 the patient has been on methylprednisolone, oral and rectal mesalamine, high-dose oral potassium, calcium, magnesium, ferrous sulfate, folic acid, A, B1, B6, C, E vitamins. At present the patient is symptom-free, and only fed orally, and his laboratory parameters are normal. In the last 5 years his body weight has been constant at 55kg, and there was no need for hospitalization. Conclusion: Our case demonstrates possible adaptation in the absorption of small intestine, therefore the expansive and uncomfortable parenteral nutrition can be replaced to enteral nutrition.