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.
Share Button
New comment
Comments
No comments for this article
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.
Related articles

Digestive Diseases Image

Spontaneous duodenal wall hematoma

DOI: 10.17235/reed.2023.9793/2023

Letter

Duodenal stenosis surgical treatment in Crohn’s disease

DOI: 10.17235/reed.2023.9521/2023

Letter

Encephalopathy in short bowel syndrome: a diagnostic challenge

DOI: 10.17235/reed.2022.8826/2022

Digestive Diseases Image

A case of duodenal-type follicular lymphoma

DOI: 10.17235/reed.2021.8233/2021

Digestive Diseases Image

Endoscopic resection of a duodenal neuroendocrine tumor

DOI: 10.17235/reed.2021.8232/2021

Digestive Diseases Image

Duodenal diverticulum causing obstructive jaundice – Lemmel’s syndrome

DOI: 10.17235/reed.2020.7516/2020

Review

Intestinal failure in adults and children

DOI: 10.17235/reed.2020.6981/2020

Digestive Diseases Image

A rare solitary duodenum plasmacytoma

DOI: 10.17235/reed.2019.6090/2018

Original

Spasmolytic effect of Jasonia glutinosa on rodent intestine

DOI: 10.17235/reed.2016.4327/2016

Citation tools
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


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 995 visits.
This article has been downloaded 242 times.

Statistics from Dimensions


Statistics from Plum Analytics

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


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology