Short-bowel syndrome in children. Quality of life in an era of improved survival
T. R. Weber, T. Tracy Jr and R. H. Connors
Department of Surgery, St Louis University School of Medicine, Mo.
A number of disorders in childhood can result in short-bowel syndrome
(small bowel length, less than 100 cm). Improved care has increased
survival in patients with short-bowel syndrome, but the quality-of-life
factors associated with such improved survival have not been examined, to
our knowledge. Sixteen consecutive pediatric patients with short-bowel
syndrome (bowel length range, 22 to 98 cm) were followed up for 2 to 10
years. The original diagnoses were as follows: necrotizing enterocolitis (n
= 6), multiple intestinal atresias (n = 4), extensive aganglionosis (n =
2), meconium peritonitis (n = 2), and midgut volvulus (n = 2). The range of
initial hospitalization was from 62 to 395 days, and 13 of 16 patients have
required readmission (two to 14 times). All patients required multiple
operations (range, two to 14 operations), including combinations of venous
access, adhesiolysis, tapering enteroplasty, reversed intestinal segments,
and pull-through procedure. Nine of 16 patients received home total
parenteral nutrition, and 12 of 16 patients required home elemental diets,
usually via pump feedings. Fifteen patients (94%) survived. Two survivors
are deaf, and one of these has mild developmental delay. Seven survivors
(age range, 6 to 10 years) attend a regular school, four while receiving
total parenteral nutrition or an elemental diet. Ten of 15 survivors are
off all nutritional support (including the child with a 22-cm small bowel),
with four others weaning. The presence or absence of an ileocecal valve did
not affect outcome. Modern nutritional support methods provide excellent
survival and quality of life for children with short-bowel syndrome.
