Short Bowel Syndrome (SBS) · Management of SBS · Colostomy · Related Links
Dear Dr. Keti, " ... In July of this year blood clots infarcted one of my kidneys, and everything but 11 inches of my small bowel. I do receive TPN. My doctor will try to re-connect the small bowel with the colon and transform everything into a colostomy. Will that make really a difference? I am afraid that down the road my only kidney will start troubles, what are my options? ... "
Deciding which type of treatment is best for you isn't easy. Your decision depends on your medical condition, lifestyle, and personal likes and dislikes.
TPN stands for Total Parenteral Nutrition. This is a complete form of nutrition, containing protein, sugar, fat and added vitamins and minerals as needed for each individual. It is administered through an intravenous infusion, usually using a central line.
supplementing enteral intake with parenteral nutrition early in the postoperative course results in better overall bowel adaptation.(3)
Before the advent of parenteral nutrition, patients with acute short bowel syndrome from mesenteric vascular infarction or massive small bowel surgical resection seldom survived. Parenteral nutrition has allowed many patients to survive indefinitely with only a foot or two of small intestine. In some, the remaining bowel eventually adapts and allows the absorption of adequate calories and protein. This is especially true of patients who retain their iliocecal valve and colon. (2)
A gradual switch to overnight tube enteral (by mouth) hydration or constant sipping of an electrolyte solution may allow discontinuation of all parenteral support. Click here for more info on EATING GUIDELINES WHICH MAY HELP CONTROL DIARRHEA
A key step in the Management of Short Bowel Syndrome is the Replacement of the fluid losses and
Control of the diarrhea. In addition one has to take care to avoid production of Renal stones because of Hyperoxaluria, which occurs both in patients with an ileal resection and in patients with a short bowel who have had a distal small bowel resection.
Despite bowel adaptation and meticulous nutritional therapy, some patients are unable to be freed from parenteral nutrition. These patients usually are those with less than 60 cm of small bowel remaining, loss of the ileum and ileocecal valve, and loss of the colon.