By Shilpa Ravella
What is intestinal failure?
Intestinal failure is a condition in which patients don’t have enough functional gut mass needed for adequate absorption to meet fluid and nutrient requirements. This can happen due to anatomical or functional loss of the gut surface area.
What causes intestinal failure?
Short bowel syndrome (short gut syndrome) after massive intestinal resection is the most common cause of intestinal failure. Massive intestinal resection can happen for various reasons, including:
- Inflammatory bowel disease (Crohn’s disease and ulcerative colitis)
- Mesenteric vascular thrombosis
- Recurrent intestinal obstruction
- Tumors (Gardner’s syndrome with desmoids causing intra-abdominal infiltration)
- Abdominal trauma
- Radiation enteritis.
Intestinal failure can happen even without short bowel syndrome. For example, dysmotility disorders (intestinal pseudo-obstruction), malabsorption and congenital diseases can all lead to intestinal failure.
How is intestinal failure managed?
Patients with intestinal failure are unable to maintain caloric intake by mouth or with a tube going into the stomach or intestines. They are fed through a vein with a liquid formula known as total parenteral nutrition (TPN). “Parenteral” means that a route other than the digestive tract is used for nutrition. TPN formulas contain protein, carbohydrates, fats, electrolytes, vitamins and minerals. They come in 2-3 liter bags, and most people get at least one bag per day. The bag is connected to an infusion pump and the entire system fits into a backpack that the patient can wear or keep nearby.
Can TPN cause problems?
While some patients do well on TPN, others suffer from complications, including:
- episodes of severe infection related to the catheter
- liver problems
- frequent episodes of severe dehydration
- complications related to venous access like vascular injury and venous thrombosis.
What is a small bowel transplant?
A small bowel transplant (intestinal transplant) is a relatively new field in solid organ transplantation. The first successful human small bowel transplant was performed in the 1980s. Since then, improved medical management and surgical techniques have led to better outcomes. Most patients who need a small bowel transplant have intestinal failure with TPN dependence and complications from TPN. A small bowel transplant is the only long-term option for these patients.
When should patients be referred for a small bowel transplant evaluation?
It’s never too early, but it can be too late to refer a patient for a small bowel transplant evaluation. There is a high risk of death among patients waiting for intestinal transplants, so early referral of patients with risk factors is important.
How to refer a patient
To refer a patient to our small bowel transplant team, please call 212-342-0896. For more information about New York Presbyterian’s Intestinal Transplant Services, visit http://www.nyp.org/transplant/transplant-services/intestinal-and-ex-vivo-transplant (from Columbia Surgery blog)