Normal Bowel Length Research Articles

Correlation Between the Total Small Bowel Length and Anthropometric Measures in Living Humans: Cross-Sectional Study

BackgroundVariation in the outcome of bariatric surgery is still an unraveled phenomenon. This variation could be multifactorial. Several reports implicate the total small bowel length (TSBL) in this process. However, the basic information regarding the normal bowel length and its relation to the anthropometric parameters of the living subject is scarce. This study aims at reporting the normal total bowel length in living adult humans and its correlation with the anthropometric parameters.MethodsThis study included 606 participants (380 females and 226 males). Their mean age was 39.8 ± 11 years, weight = 135.7 ± 29.7 kg, height = 165 ± 9 cm, and BMI = 49.5 ± 7.5 kg/m2.The mean TSBL was 630 ± 175 cm. There was a statistically significant but very weak positive correlation but between the TSBL and both weight and height.Males had significantly higher weight and were significantly taller compared with females. TSBL was significantly longer in males at 661.5 ± 186 cm versus 612 ± 164 cm in females.ConclusionThe study reports an average TSBL greater than what is reported in the literature from living humans with a greater range of variation. There is no clinically important correlation between the TSBL and the weight and height of the individual participants in this series.

Multiple jejunoileal and colonic atresias: Case report and review of literature

Multiple intestinal atresia (MIA) associated with colonic atresia is very rare, especially with almost normal bowel length. This report deals with a case of multiple jejunoileal atresia associated with descending colon atresia, which was managed by multiple resection and primary anastomoses without use of stents and with total parenteral nutrition. Literature on the genesis, management and survival of MIA is reviewed.

Intestinal Transplant in Children with Short Bowel Syndrome of Neonatal Onset

Background: Children with short bowel syndrome starting in the neonatal period (NB- SBS) are exposed to many live-threatening complications that can affect their outcome before and after transplantation. Our aim was to assess the outcome of this group of children in a single transplant center. Material and methods: Retrospective review of pediatric intestinal transplants performed between 1994 and 2010 at our center. All patients with short bowel syndrome of neonatal onset were included. Those with motility disorders or intestinal epithelium disease but normal bowel length were not included in spite of the congenital character of these diseases. Pre-transplant status, weight, time on the waiting list, type of graft, patient survival, graft survival and immunological complications were compared between patients with NB-SBS and the rest of the children included. T-Student test, Chi-square tests and log-rank were used to compare quantitative, qualitative and survival data respectively. Results: A total of 180 pediatric intestinal transplants were performed in children between 1994 and 2010. Of them, 104 (57%) suffered from short bowel syndrome of neonatal onset, 96 (53%) were male and 85 (46%) females. Patient survival at 1, 5 and 10y were similar between patients with NB-SGS and other children (61, 42, 32% vs 62, 42, 34%; respectively). Graft survival was also similar in the three periods for the two groups (61, 39, 33% vs 51, 35, 32%, respectively). Waiting time was lower but not significantly in the NB-SBS group (77.3 vs 98.8 days) Type of graft distribution was similar in both groups except for the absence of MMV in the group of NB-SBS that contrast to 11% of these grafts in other children. Weight at transplantation was significantly lower in the NB-SGS group (10.2±16.8 vs 17.5±6.8 Kg). Regarding pre-transplant status patients in the NB-SGS were more likely to be in the ICU (24. 2 vs 10.9%) and less at home (44.4 vs 62.2%) compared to patients in the other group. Pre transplant creatinin level was similar the two groups but pre transplant albumin, bilirubin, INR and PT were more seriously impaired in patients in the NB-SGS group compared to other children. Recipient/donor weight rate was similar in both groups (1.2 vs 1.1) in NB-SGS vs others. PTLD was most frequent in children with NB-SBS compared to others (18.1 vs 8.5%). Rejection, GVHD and infectious complications were similar in the two groups. Conclusions: Patients suffering from NB-SGS had similar patient and graft survival compared to the rest of children that received an intestinal transplant. Liver function tests were more impaired in the NB-SGS group, and they were more prone to be in the ICU at the moment of transplant than the rest of children. The rest of pre and post-transplant variables examined did not show any difference.

Tissue-engineered small intestine

“An ideal intestinal replacement would be derived from immunocompatible cells, would grow with the recipient, and be fully capable of performing all metabolic and physiologic functions of native small bowel.” Short bowel syndrome (SBS) is defined by both the metabolic and physiologic disturbances observed with significant truncation of normal bowel length. With a 70–75% reduction in small intestine length, alterations in fluid and nutrient bal ance occur with potentially life threatening consequences. These include profound decrease in the absorption of carbohydrates and protein as well as severe mineral and vitamin deficiencies. Additional sequalae include formation of renal and biliary calculi, low body weight, failure to thrive and death [1–3]. Both adults and children may be affected. In the adult population, bowel resection secondary to mesenteric ischemia, trauma, inflammatory bowel disease and malignancy are common etiologies. Children are susceptible to a wide range of congenital or acquired conditions such as intestinal atresia, volvulus and necrotizing enterocolitis. The incidence of SBS is estimated to be 24.5 per 100,000 live births and is associated with 30% 5-year mortality [2]. Current treatment options are inadequate and are focused on nutritional supplementation via total parenteral nutrition or intestinal replacement with transplanted allograft. The risks of hepatic failure and central line sepsis associated with prolonged total parenteral nutrition have been described [4]. Although outcomes for small intestine transplantation are improving, this therapy has disadvantages of supply shortages, rejection and lifelong immunosuppression. An ideal intestinal replacement would

Pediatric Short Bowel Syndrome

To determine predictors of survival and of weaning off parenteral nutrition (PN) in pediatric short bowel syndrome (SBS) patients. Pediatric SBS carries extensive morbidity and high mortality, but factors believed to predict survival or weaning from PN have been based on limited studies. This study reviews outcomes of a large number of SBS infants and identifies predictors of success. Multivariate Cox proportional hazards analysis was conducted on 80 pediatric SBS patients. Primary outcome was survival; secondary outcome was ability to wean off PN. Nonsignificant covariates were eliminated. P < 0.05 was considered significant. Over a mean of 5.1 years of follow-up, survival was 58 of 80 (72.5%) and 51 weaned off PN (63.8%). Cholestasis (conjugated bilirubin > or =2.5 mg/dL) was the strongest predictor of mortality (relative risk [RR] 22.7, P = 0.005). Although absolute small bowel length was only slightly predictive, percentage of normal bowel length (for a given infant's gestational age) was strongly predictive of mortality (if <10% of normal length, RR of death was 5.7, P = 0.003) and of weaning PN (if > or =10% of normal, RR of weaning PN was 11.8, P = 0.001). Presence of the ileocecal valve (ICV) also strongly predicted weaning PN (RR 3.9, P < 0.0005); however, ICV was not predictive of survival. Cholestasis and age-adjusted small bowel length are the major predictors of mortality in pediatric SBS. Age-adjusted small bowel length and ICV are the major predictors of weaning from PN. These data permit better prediction of outcomes of pediatric SBS, which may help to direct future management of these challenging patients.

3-0 methylglucose uptake as a marker of nutrient absorption and bowel length in pediatric patients.

Inert carbohydrate probes are commonly used to assess intestinal permeability; we have previously shown that the actively transported moiety 3-0 methylglucose (3-0 MG) is a useful marker of intestinal surface area and nutrient absorption in animal models of short bowel syndrome (SBS). This study examines the correlation of 3-0 MG absorption with nutrient absorption, bowel length, and the tolerance of enteral feeds in pediatric patients. Fifteen children (1 month to 15 years in age) were studied after intestinal surgery. All had a stoma, 2 were > 1 year of age, the remainder had surgical intervention as a neonate or within the first month of life. Eight had SBS (50% expected bowel length for age). Bowel length was measured intraoperatively. Nutrient absorption was quantified with a 48-hour bowel study, measuring fat, protein, and carbohydrate output directly. 3-0 MG absorption and intestinal permeability were quantified using a solution containing 30 mg/mL 3-0 MG, 20 mg/mL mannitol and 30 mg/mL lactulose (osmolarity 352, given at 1 mL/kg via feeding tube). Subsequent urine production was collected for 8 hours, and probe recovery measured using HPLC. 3-0 MG absorption was significantly correlated with nutrient absorption. The correlation with protein absorption was r2 = .59, fat r2 = .62 and carbohydrate r2 = .56. The correlation between 3-0 MG absorption and bowel length was r2 = .58. 3-0 MG absorption was significantly lower in SBS patients vs patients with normal bowel length (15.8 +/- 6.7 vs 30.5 +/- 10.2%). 3-0 MG absorption also correlated with the ability to tolerate enteral feeds (r2 = .38; p < .03 for all comparisons). 3-0 MG may be a useful marker of nutrient absorption and bowel length in pediatric patients with short bowel syndrome. The simplicity and reproducibility of the method make it an attractive option for following patient outcomes. Further studies are suggested to determine the utility of these markers in directing the clinical management of patients.

2.8 Management of patients with dissection of the descending thoracic aorta — A comparative study between closing and non-closing dissections

This report describes the individualized operative therapy in 75 patients with intestinal atresia or stenosis based on pathological findings (1972–1978). Location of obstruction was duodenal in 30, jejunoileal in 38, and colonic in 7. Duodenal atresia was noted in 23 infants and stenosis in 7. Associated anomalies were observed in 23 patients, prematurity in 11, polyhydramnios in 11, and Down's Syndrome in 10. Operative treatment included duodenoduodenostomy (DD) in 19 patients, duodenotomy and web excision in 9, and side-to-side duodenojejunostomy (DJ) in 2. Both (DJ) cases needed revision to (DD) because of obstruction. A gastrostomy was used in all cases. Jejunoileal atresia occurred in 33 patients and stenosis in 5. Operations included wide proximal resection and endto-end anastomosis in 18 patients with normal bowel length, minimal resection with antimesenteric tapering enteroplasty (using autostaples) and anastomosis in 9 patients with foreshortened bowel, and resection and double barrel enterostomy in 6 with peritonitis or questionable bowel viability. Seventy percent received total parenteral nutrition (TPN). Six patients with colon atresia and one infant with stricture of the rectosigmoid survived initial colostomy and subsequent anastomosis at 3 to 6 mo of age. Survival for duodenal cases was 84%, jejunoileal 90%, and colonic 100%. Individualizing the operative management according to pathologic findings and TPN support when indicated improve operative survival in infants with intestinal atresia.

Effect of removal of pancreaticobiliary secretions on adaptation to short bowel in orally nourished rats

To evaluate the need for intraluminal pancreaticobiliary secretions for mucosal adaptation in animals with short bowel, groups of paired rats were prepared with: 1) normal bowel length, 2) 60% proximal small bowel bypass, and 3) similar bypass of distal bowel. One animal in each pair underwent operative diversion of pancreaticobiliary secretions to distal (group 1) or bypassed intestine (groups 2 and 3). Rats were fed an elemental diet and killed 1 month later. Mucosal wet weight, protein content, and DNA content were measured in comparable segments of proximal jejunum and mid-small bowel. Within each group the patterns of response of the three measures of mucosal mass were similar. Group 1: removal of secretions was associated with a 20 to 30% increase in mass in both segments. Group 2: after proximal bypass, mass doubled in mid-small bowel (in continuity) whether or not pancreaticobiliary secretions were removed. Group 3: after distal bypass, no change in mass was apparent in the jejunum even with removal of secretions. We conclude that intraluminal pancreaticobiliary secretions are not required for maintenance of mucosal mass or adaptation to short bowel in animals fed an elemental diet.

Operative management of intestinal atresia and stenosis based on pathologic findings

This report describes the individualized operative therapy in 75 patients with intestinal atresia or stenosis based on pathological findings (1972–1978). Location of obstruction was duodenal in 30, jejunoileal in 38, and colonic in 7. Duodenal atresia was noted in 23 infants and stenosis in 7. Associated anomalies were observed in 23 patients, prematurity in 11, polyhydramnios in 11, and Down's Syndrome in 10. Operative treatment included duodenoduodenostomy (DD) in 19 patients, duodenotomy and web excision in 9, and side-to-side duodenojejunostomy (DJ) in 2. Both (DJ) cases needed revision to (DD) because of obstruction. A gastrostomy was used in all cases. Jejunoileal atresia occurred in 33 patients and stenosis in 5. Operations included wide proximal resection and endto-end anastomosis in 18 patients with normal bowel length, minimal resection with antimesenteric tapering enteroplasty (using autostaples) and anastomosis in 9 patients with foreshortened bowel, and resection and double barrel enterostomy in 6 with peritonitis or questionable bowel viability. Seventy percent received total parenteral nutrition (TPN). Six patients with colon atresia and one infant with stricture of the rectosigmoid survived initial colostomy and subsequent anastomosis at 3 to 6 mo of age. Survival for duodenal cases was 84%, jejunoileal 90%, and colonic 100%. Individualizing the operative management according to pathologic findings and TPN support when indicated improve operative survival in infants with intestinal atresia.