MULTIDISCIPLINARY MANAGEMENT OF A CASE OF INTESTINAL FAILURE DUE TO SHORT BOWEL SYNDROME IN GARDNER SYNDROME

Abstract

Objective There still is little attention about both nutritional/metabolic consequences and multi-organ involvement after intestinal surgery. Our multidisciplinary team aimed to an integrated approach to short bowel syndrome (SBS). Research Methods & Procedures A 37-years-old man affected by Gardner Syndrome, who previously underwent colectomy and several small bowel resections elsewhere without receiving appropriate nutritional prescriptions, was admitted into our hospital to be evaluated for intestinal transplant: biochemistry showed acute renal failure and multiple critical dysionias and the patient referred habitual copious liquid output, also containing undigested food, from ileostomy; he had lost 30 kg (-40% usual body weight, BW) in the last month. He promptly underwent nutritional assessment and, consequently, nutritional treatment: firstly we corrected dysionias and immediately started thiamin supplementation, thereafter we prescribed a personalized semielemental low-fiber diet per os, parceled out on 5-6 meals, and we started a personalized admixture parenteral nutrition support (PN). Regardless of appropriate evidences, the patient finally refused to give his consent to intestinal transplant, he was then discharged in PN and personalized diet per os. Results Despite severe dehydration and malnutrition, we early achieved and maintained hydro-electrolytic balance, thus recovering renal enhancement; besides, Refeeding Syndrome was adequately prevented and, beyond rehydration, the patient also started regaining BW. Conclusions SBS can result in both intestinal and renal failure. It needs a multidisciplinary approach, including early and appropriate nutritional assessment and treatment. When intestinal transplant is not possible, even if recommended, PN remains the main therapeutic strategy.