Intestinal Rehabilitation in a Patient with Crohn Severe Disease and Short Bowel Syndrome
Introduction: Crohn's disease (CD) is uncommon in Peru and may be a cause of short bowel syndrome (SBS), mainly the severe form in young patients. Medical and surgical management is complex. We present the case of a young patient with CD operated by the Intestinal Failure Unit (IFU) with 2-year foll...
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| Autores principales: | , , |
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| Formato: | Artículo |
| Lenguaje: | inglés |
| Publicado: |
2017
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| Acceso en línea: | Enlace permanente (DOI o Handle) |
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| Sumario: | Introduction: Crohn's disease (CD) is uncommon in Peru and may be a cause of short bowel syndrome (SBS), mainly the severe form in young patients. Medical and surgical management is complex. We present the case of a young patient with CD operated by the Intestinal Failure Unit (IFU) with 2-year follow-up. Case Description: Male of 25 years. In 2014 he performed a laparoscopy for adhesion release and biopsy suture in wedge for intestinal obstruction. Two days later, relaparotomy, intestinal resection and jejunostomy (at 120 cm of the Treitz ligament) are performed by jejunal suture dehiscence and multiple intestinal perforations. Curses with massive low digestive hemorrhage; patient is submitted to a new intestinal resection under an endoscopic guide, leaving 50 cm of ostomized jejunum and 70 cm of ostomized ileum. The pathological anatomy reports compatible with EC. Control of intra-abdominal infection was achieved and received Parenteral Nutrition (PN) for 1 year 5 months. During this period he presented digestive hemorrhage of medical management, Central Venous Catheter infections, pneumonia, myelodysplastic syndrome with pancytopenia. He also received biological therapy from Infliximab. Seven months later the autologous gastrointestinal reconstruction (AGIR) was performed and failed. Administration of glutamine by nasojejunal probe and through a jejunal re-infusion resulted in partial intestinal adaptation and allowed the administration of mixed nutrition (domiciliary for 3 months), then AGIR (jejunum 45 cm and ileum 70 cm) was successfully performed. At 3 weeks, he developed a low-flow intestinal fistula that was cured with enteral nutrition. Conclusion: Patients with complicated CD may require massive bowel resection and cause SBS. They are more susceptible to infections due to background disease and immunosuppressive treatment. It is difficult to achieve medical intestinal rehabilitation due to multiple infectious intercurrences. The best anti-infection conditions were achieved with the home management of Parenteral Nutrition and allowed AGIR. The management of these patients must be in charge of the IFU. |
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