Year 2018 / Volume 110 / Number 1
Case Report
Duodenal lengthening in an adult with ultra-short bowel syndrome. A case report

59-62

DOI: 10.17235/reed.2017.5187/2017

Javier Bueno, Rosa Burgos, Susana Redecillas, Manuel López, Joaquin Balsells,

Abstract
Background: We have recently demonstrated the feasibility of lengthening the duodenum in children with short bowel syndrome and a dilated duodenum. This procedure gains additional intestinal length in a challenging area of autologous gut reconstruction. Herein, we report the successful application of this technique in an adult with ultra-short bowel syndrome. Case report: A 25-year-old man with a history of mid-gut volvulus was referred to our center for intestinal transplant evaluation. Only a megaduodenum stump that reached as far as the third portion (30 cm of length) and the colon up to the hepatic flexure in the form of a mucous fistula was retained. A gastrostomy tube drained gastric and bilio-pancreatic secretions (output range: 2.5-4 liters/day). The time spent on parenteral nutrition (3 liters/day; 1500 calories/day) and I.V. fluid (1.5-2 liters/day) administration was 24 hours per day. The patient underwent duodenal lengthening and tapering with 7 sequential transverse applications (5 of 45 mm and 2 of 60 mm) of an endoscopic stapler on the anterior and posterior walls of the duodenum, respecting the pancreatic parenchyma and end-to-side duodeno-colonic anastomosis. The final duodenal length was 83 cm. The pre-lengthening citrulline level increased from 13.6 micromol/L to 21.6 micromol/L one year post-lengthening. After 24 month of follow-up, the time on a parenteral pump was shortened to 9 hours during the night. The volume and calorie requirements were also reduced by half. Discussion: Duodenal lengthening may be effective as part of the autologous intestinal reconstruction armamentarium in adults with short bowel syndrome.
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References
1. Kim HB, Lee PW, Garza J et al. Serial transverse enteroplasty for short bowel syndrome: a case report. J Pediatr Surg, 2003; 38:881–5.
2. Jones BA, Hull MA, Potanos KM et al. Report of 111 consecutive patients enrolled in the International Serial Transverse Enteroplasty (STEP) Data Registry: a retrospective observational study. J Am Coll Surg 2013; 216:438-46.
3. Sudan D, Thompson J, Botha J et al. Comparison of intestinal lengthening procedures for patients with short bowel syndrome. Ann Surg, 2007; 246: 593–604.
4. Bueno J, Redecillas S, GarcÍa L, et al. Duodenal lengthening in short bowel with dilated duodenum. J Pediatr Surg. 2015; 50:493-6.
5. Pironi L, Joly F, Forbes A, Colomb V. Long-term follow-up of patients on home parenteral nutrition in Europe: implications for intestinal transplantation. Gut. 2011; 60:17-25
6. Grant D, Abu-Elmagd K, Mazariegos G, et al. Intestinal transplant registry report: global activity and trends. Am J Transplant. 2015; 15(1):210-9
7. Diamanti A(1), Conforti A, Panetta F, et al. Long-term outcome of home parenteral nutrition in patients with ultra-short bowel syndrome. J Pediatr Gastroenterol Nutr. 2014; 58(4):438-42.
8. 10. Zhang XW, Abudoureyimu A, Zhang TC, et al. Tapering duodenoplasty and gastrojejunostomy in the management of idiopathic megaduodenum in children. J Pediatr Surg. 2012; 47:1038-42.
9. Crenn P, Coudray-Lucas C, Thuillier F, et al. Postabsorptive plasma citrulline concentration is a marker of absorptive enterocyte mass and intestinal failure in humans. Gastroenterology 2000; 119:1496-505.
10. Santarpia L, Catanzano F, Ruoppolo M, et al. Citrulline blood levels as indicators of residual intestinal absorption in patients with short bowel syndrome. Ann Nutr Metab 2008; 53:137-42.
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Bueno J, Burgos R, Redecillas S, López M, Balsells J. Duodenal lengthening in an adult with ultra-short bowel syndrome. A case report. 5187/2017


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Publication history

Received: 23/07/2017

Accepted: 22/09/2017

Online First: 06/11/2017

Published: 12/01/2018

Article revision time: 57 days

Article Online First time: 106 days

Article editing time: 173 days


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