Diseases Causing Intestinal Failure

Diseases leading to intestinal failure include loss of bowel length, loss of bowel function, or conventionally unresectable tumors involving the bowel or its feeding vessels. Short-bowel syndrome, the loss of intestinal length and absorptive surface areas due to surgical resection, are the most common cause of intestinal failure leading to bowel transplantation. The loss of mucosal absorptive surface area is associated with malabsorption and rapid transit through the jejunoileum leading to malnutrition, recurrent dehydration, and electrolyte abnormalities. Short-bowel syndrome can be caused by a variety of conditions and diseases in adults such as thrombosis or embolism to the superior mesenteric vessels, inflammatory bowel disease, volvulus, radiation enteritis, trauma or other causes of infarction.

In pediatric patients, most frequent causes of short-bowel syndrome are malrotation, volvulus, necrotizing enterocolitis, jejunoileal artresias, gas-troschisis, and omphalocele among other congenital disorders. Transplant candidacy has to be considered in the context of alternatives to transplantation including the potential for rehabilitation or successful lifelong parenteral nutrition. In a large series, about 20% of adult patients with less than 100 cm of residual intestine could be weaned from TPN. In children, less than 30 cm of jejunoileum, lack of entero-colonic continuity, and lack of feeding tolerance early after birth correlate to failure of weaning from parenteral nutrition [14].

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