Nutrient Management in a Patient with Severe Short Bowel Syndrome
A 67-year-old man was admitted to our hospital because of acute abdominal pain. We performed an emergency laparotomy under a diagnosis of acute abdomen. Extensive bowel necrosis caused by a mesenteric circulatory disturbance was found, and a broad resection including the small intestine and the righ...
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| Published in | Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 25; no. 5; pp. 743 - 746 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japanese Society for Abdominal Emergency Medicine
2005
日本腹部救急医学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-2242 1882-4781 |
| DOI | 10.11231/jaem1993.25.743 |
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| Abstract | A 67-year-old man was admitted to our hospital because of acute abdominal pain. We performed an emergency laparotomy under a diagnosis of acute abdomen. Extensive bowel necrosis caused by a mesenteric circulatory disturbance was found, and a broad resection including the small intestine and the right and transverse colon was performed. A primary anastomosis was performed because the remnant small intestine was too short to perform an ileostomy. Despite the presence of peritonitis, we were able to save the patient's life ; no severe complications, like ruptured sutures, occurred. The patient's residual small intestine was only about 10 cm in length, causing significant digestive malabsorption. The patient is presently receiving short-chain fatty acids and glutamine, administered as intestinal trophic factors, in an effort to improve intestinal digestive absorption. Patients with short bowels and digestive malabsorption may require additional therapeutic agents to wean them from TPN. |
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| AbstractList | A 67-year-old man was admitted to our hospital because of acute abdominal pain. We performed an emergency laparotomy under a diagnosis of acute abdomen. Extensive bowel necrosis caused by a mesenteric circulatory disturbance was found, and a broad resection including the small intestine and the right and transverse colon was performed. A primary anastomosis was performed because the remnant small intestine was too short to perform an ileostomy. Despite the presence of peritonitis, we were able to save the patient's life ; no severe complications, like ruptured sutures, occurred. The patient's residual small intestine was only about 10 cm in length, causing significant digestive malabsorption. The patient is presently receiving short-chain fatty acids and glutamine, administered as intestinal trophic factors, in an effort to improve intestinal digestive absorption. Patients with short bowels and digestive malabsorption may require additional therapeutic agents to wean them from TPN.
症例は67歳男性。2001年10月, 脳梗塞後のリハビリ中に急な腹部激痛を発症した。急性腹症で緊急手術を施行。上腸間膜動脈支配全領域の腸管に壊死を認め, Treitz靭帯より10cm肛門側の空腸から横行結腸脾曲まで切除した。空腸切除端の人工肛門造設も考えたが, 腹壁まで腸管を誘導し得ないため空腸と下行結腸を一期的に吻合した。縫合不全発生に陥ることなく, 救命することができた。現在, 高度の吸収障害を認める短腸症候群の状態にあるが, 吸収能向上を目指し腸管のtrophicfactorでもあるグルタミン, 短鎖脂肪酸を経口投与し, 徐々にQOLの向上を認めるほか, 栄養評価指標も安定しており, その有用性が確認されている。消化吸収障害のある短腸症候群の患者へのグルタミン, 短鎖脂肪酸の臨床応用は, 今後期待される治療法の一つと思われた。 A 67-year-old man was admitted to our hospital because of acute abdominal pain. We performed an emergency laparotomy under a diagnosis of acute abdomen. Extensive bowel necrosis caused by a mesenteric circulatory disturbance was found, and a broad resection including the small intestine and the right and transverse colon was performed. A primary anastomosis was performed because the remnant small intestine was too short to perform an ileostomy. Despite the presence of peritonitis, we were able to save the patient's life ; no severe complications, like ruptured sutures, occurred. The patient's residual small intestine was only about 10 cm in length, causing significant digestive malabsorption. The patient is presently receiving short-chain fatty acids and glutamine, administered as intestinal trophic factors, in an effort to improve intestinal digestive absorption. Patients with short bowels and digestive malabsorption may require additional therapeutic agents to wean them from TPN. |
| Author | Ohno, Kei Hirata, Koichi Takasaka, Hajime Yoshikawa, Tomomichi Sasaki, Kazuaki Nishikawa, Noriko |
| Author_FL | 吉川 智道 高坂 一 大野 敬 平田 公一 佐々木 一晃 西川 紀子 |
| Author_FL_xml | – sequence: 1 fullname: 西川 紀子 – sequence: 2 fullname: 佐々木 一晃 – sequence: 3 fullname: 高坂 一 – sequence: 4 fullname: 吉川 智道 – sequence: 5 fullname: 大野 敬 – sequence: 6 fullname: 平田 公一 |
| Author_xml | – sequence: 1 fullname: Nishikawa, Noriko organization: Department of Surgery, Doto Hospital – sequence: 1 fullname: Yoshikawa, Tomomichi organization: Department of Surgery, Doto Hospital – sequence: 1 fullname: Sasaki, Kazuaki organization: Department of Surgery, Doto Hospital – sequence: 1 fullname: Ohno, Kei organization: Department of Surgery, Doto Hospital – sequence: 1 fullname: Hirata, Koichi organization: First Department of Surgery, Sapporo Medical University School of Medicine – sequence: 1 fullname: Takasaka, Hajime organization: Department of Surgery, Doto Hospital |
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| Publisher | Japanese Society for Abdominal Emergency Medicine 日本腹部救急医学会 |
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| References | 8) 大村健二, 疋島寛, 森田克哉, ほか: 急性上腸問膜動脈閉塞症の診断と治療. 日臨外会誌: 1991; 52: 990-994. 5) Sschs SM, Morton JH, Schwartz SI: Acute mesentric ischemia. Surgery 1982; 92: 646-653. 4) 井口雅史, 西村元一, 三輪晃一, ほか: 急性上腸間膜動脈閉塞症に対する診断・治療の問題点.日腹部救急医会誌1999; 19: 329335. 1) 薄見昭武: 急性上腸間膜動脈閉塞.小柳仁, 松野正紀, 北島政樹.標準外科学, 第9版, 東京, 医学書院, 2001: 473. 15) Craig RM, Neumann T, Jeejeebhoy KN, et al: Severe hepatocellular reaction resembling alcohol hepatitis with cirrhosis after massive small bowel resection and prolonged total parenteral nutrition. Gastroenterology 1980; 71: 131-137. 16) Byne TA, Persinger RE Young, LS, et al: A new treatment for patients with short-bowel syndrome: Growth hormone, glutamine, and a modified diet. Ann Surg 1995; 222: 243-255. 3) 倉田悟, 白澤文吾, 本郷碩, ほか: 急性上腸間膜動脈閉塞症20例の治療経験. 日血管外科会誌1995;4: 719-725. 10) Wilemore DW, Lacay JM, Soultanakis RP, et al: Factors predicting a successful outcome after phar macologic bowel compensation. Ann Surg 226: 288-293, 1997. 13) Weinstein LD, Shoemaker CP, Hersh T, et al: Enhanced intestinal absoption after small bowel resection in man. Arch Aurg 1969; 99: 560-562. 7) Ballard JL, Stone WM, Hallet JW, et al: A critical analysis of adjuvant techniques used to assess bowel viability in acute mesenteric ischemia. Am Surg 1993; 59: 309-311. 12) 和佐勝史, 高木洋治, 山東勤弥ほか: 短調症候群におけるTPN離脱のための残存小腸の条件.日腹部救急会誌18: 1093-1098, 1998 9) Thompson JS: Management of the short bowel syndrome. Gastroenterol Clinic North Am 1994; 23: 403 420. 6) Levy PJ, Krausz MM, Manny J: Acute mesentric ischemia: Improved result-A retrospective analysis of ninety-two patients. Surgery 1990; 107: 372-380. 11) Rothstein RD, Rombeau JL. Nutrient pharmacotherapy for gut mucosal disease. Gasteroeanterol Clim North Am 27: 387 401, 1998. 17) 佐々木雅也, 荒木克己, 馬場忠雄: 【臨床栄養Update】補助食品と栄養療法短鎖脂肪酸. Medicina (0025-76917) 2002;39: 281-283. 14) Feldmann EJ, Dowling RH, McNaughton J, et al: Effects of oral versus intravenous nutrition on intestinal adaptation after small bowel resection in the dog.Gastroenterology 1976; 70: 712-719. 2) Windmueller HG: Glutamine utilization by the small intestine. Adv Enzymol 1982; 53: 201-237. |
| References_xml | – reference: 11) Rothstein RD, Rombeau JL. Nutrient pharmacotherapy for gut mucosal disease. Gasteroeanterol Clim North Am 27: 387 401, 1998. – reference: 14) Feldmann EJ, Dowling RH, McNaughton J, et al: Effects of oral versus intravenous nutrition on intestinal adaptation after small bowel resection in the dog.Gastroenterology 1976; 70: 712-719. – reference: 3) 倉田悟, 白澤文吾, 本郷碩, ほか: 急性上腸間膜動脈閉塞症20例の治療経験. 日血管外科会誌1995;4: 719-725. – reference: 9) Thompson JS: Management of the short bowel syndrome. Gastroenterol Clinic North Am 1994; 23: 403 420. – reference: 12) 和佐勝史, 高木洋治, 山東勤弥ほか: 短調症候群におけるTPN離脱のための残存小腸の条件.日腹部救急会誌18: 1093-1098, 1998 – reference: 6) Levy PJ, Krausz MM, Manny J: Acute mesentric ischemia: Improved result-A retrospective analysis of ninety-two patients. Surgery 1990; 107: 372-380. – reference: 4) 井口雅史, 西村元一, 三輪晃一, ほか: 急性上腸間膜動脈閉塞症に対する診断・治療の問題点.日腹部救急医会誌1999; 19: 329335. – reference: 7) Ballard JL, Stone WM, Hallet JW, et al: A critical analysis of adjuvant techniques used to assess bowel viability in acute mesenteric ischemia. Am Surg 1993; 59: 309-311. – reference: 16) Byne TA, Persinger RE Young, LS, et al: A new treatment for patients with short-bowel syndrome: Growth hormone, glutamine, and a modified diet. Ann Surg 1995; 222: 243-255. – reference: 5) Sschs SM, Morton JH, Schwartz SI: Acute mesentric ischemia. Surgery 1982; 92: 646-653. – reference: 13) Weinstein LD, Shoemaker CP, Hersh T, et al: Enhanced intestinal absoption after small bowel resection in man. Arch Aurg 1969; 99: 560-562. – reference: 15) Craig RM, Neumann T, Jeejeebhoy KN, et al: Severe hepatocellular reaction resembling alcohol hepatitis with cirrhosis after massive small bowel resection and prolonged total parenteral nutrition. Gastroenterology 1980; 71: 131-137. – reference: 1) 薄見昭武: 急性上腸間膜動脈閉塞.小柳仁, 松野正紀, 北島政樹.標準外科学, 第9版, 東京, 医学書院, 2001: 473. – reference: 2) Windmueller HG: Glutamine utilization by the small intestine. Adv Enzymol 1982; 53: 201-237. – reference: 10) Wilemore DW, Lacay JM, Soultanakis RP, et al: Factors predicting a successful outcome after phar macologic bowel compensation. Ann Surg 226: 288-293, 1997. – reference: 8) 大村健二, 疋島寛, 森田克哉, ほか: 急性上腸問膜動脈閉塞症の診断と治療. 日臨外会誌: 1991; 52: 990-994. – reference: 17) 佐々木雅也, 荒木克己, 馬場忠雄: 【臨床栄養Update】補助食品と栄養療法短鎖脂肪酸. Medicina (0025-76917) 2002;39: 281-283. |
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| Title | Nutrient Management in a Patient with Severe Short Bowel Syndrome |
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