Supplementation of nutritional fluid and electrolyte balance by perfusion of an isolated small bowel loop in a patient with Crohn's disease

Abstract

Delayed reanastamosis of small bowel in Crohn's disease has been made possible, largely by parenteral nutrition. We describe a patient with multiple resections resulting in loss of all the small and large bowel except the duodenum and 70 cms of proximal jejunum ending in a jejunostomy and a 150 cm long isolated loop of jejuno-ileum. The short proximal bowel proved adequate for energy and protein nutrition, with small frequent meals but gave rise to a persistent negative balance of water, sodium, potassium and magnesium. This was corrected by overnight perfusion of the isolated loop with an electrolyte solution with added glucose polymer to enhance sodium absorption. The critical rate of perfusion and concentration of glucose polymer were determined by a series of studies. The patient and her husband carried out this regimen for a year at home. The isolated loop was subsequently reanastamosed to the proximal jejunum allowing resumption of normal eating without further electrolyte disturbance.