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Current Management of Intestinal Failure in Children

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Contemporary Pancreas and Small Bowel Transplantation

Part of the book series: Organ and Tissue Transplantation ((OTT))

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Abstract

Intestinal failure is the complete loss of the alimentary tract’s ability to absorb nutrients and is often the end result of progressive short bowel syndrome (SBS), defined as the malabsorption of nutrients secondary to either anatomical or functional loss of a significant portion of the small intestine. Common etiologies leading to anatomic (i.e., genetic or secondary to resection) and functional loss include necrotizing enterocolitis, volvulus, intestinal atresia, gastroschisis, as well as Hirschsprung’s, chronic intestinal pseudoobstruction, and inflammatory bowel disease, respectively. Maintenance of nutrition, managing risks of infection, and monitoring proper growth are vital components of caring for children with SBS. Parenteral nutrition (PN) is the initial standard of care that provides proper hydration, repletion of electrolytes, and provision of calories to enable normal growth. It also provides the gut opportunity to adapt and grow with the ultimate goal of regaining enteral autonomy. However, complications of PN including parenteral nutrition-associated cholestasis (PNAC), catheter-related bloodstream infections, intestinal bacterial overgrowth, and nutrient deficiencies must be managed. Persistence of intestinal failure can be managed surgically by autologous gut lengthening via longitudinal intestinal lengthening and tailoring (LILT) and serial transverse enteroplasty (STEP) operations in order to increase surface area for absorption and subsequent autonomy.

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Author information

Authors and Affiliations

  1. University of Virginia School of Medicine, Charlottesville, VA, USA

    Rick D. Vavolizza, Patrick Melmer & Sara K. Rasmussen

  2. Hillman Center for Pediatric Transplantation, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA

    George V. Mazariegos

  3. Department of General Surgery, Division of Pediatric Surgery, University of Virginia, Charlottesville, VA, USA

    Sara K. Rasmussen

  4. Surgery, Grand Strand Medical Center/University of South Carolina, Myrtle Beach, VA, USA

    Patrick Melmer

Authors
  1. Rick D. Vavolizza
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  2. Patrick Melmer
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  3. George V. Mazariegos
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  4. Sara K. Rasmussen
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Corresponding author

Correspondence to Rick D. Vavolizza .

Editor information

Editors and Affiliations

  1. Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA

    Ashesh Piyush Shah

  2. Capital Health Cancer Center, Pennington, NJ, USA

    Cataldo Doria

  3. Porter Adventist Hosptial, Denver, CO, USA

    James W. Lim

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Vavolizza, R.D., Melmer, P., Mazariegos, G.V., Rasmussen, S.K. (2019). Current Management of Intestinal Failure in Children. In: Shah, A., Doria, C., Lim, J. (eds) Contemporary Pancreas and Small Bowel Transplantation . Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-05257-1_23

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  • DOI: https://doi.org/10.1007/978-3-319-05257-1_23

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-05256-4

  • Online ISBN: 978-3-319-05257-1

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