No abstract available.
Short Bowel Syndrome*

Management of intestinal strictures associated with Crohn's disease (CD) is clinically challenging despite advanced medical therapy directed toward mucosal healing to positively influence the natural course of CD-associated complications. Although medical therapy is available for inflammatory strictures, therapy of fibrostenotic strictures is the domain of surgery and endoscopy. Endoscopic balloon dilation (EBD) has been recognized as a well-established first-line procedure in terms of safety and efficacy. Although surgery is a valuable treatment modality for the management of CD-related strictures, EBD can help prevent multiple surgical interventions, which might in the long-term lead to a risk of short bowel syndrome. In this review we discuss requirements, techniques, safety, short- and long-term outcomes, as well as combinations of this procedure with surgical and medical treatment in CD-associated intestinal strictures.
Constriction, Pathologic* ; Crohn Disease ; Endoscopy ; Short Bowel Syndrome

We present a patient with short bowel syndrome (SBS), successfully treated with the Kampo medicine, shigyakuto-kagen. The patient was a 74 year old female complaining of severe diarrhea, abdominal distention, and abdominal pain. She was diagnosed as having tuberculous peritonitis when she 23 years of age. A partial resection of the small bowel and colon was performed for ileus, secondary to her tuberculous peritonitis, eventually causing her short bowel syndrome (SBS). Severe abdominal distention and pain had persisted even after the resection surgery. She consulted our clinic at 60 years of age in order to receive Kampo therapy. Bukuryoshigyakuto was prescribed, and her condition markedly improved. Zanthoxylum piperitum was added to bukuryoshigyakuto, and the regimen had the reactivity of daikenchuto. She regained her pre-operation body weight. It is significant that this case was followed for 14 years with therapy based on Kampo diagnosis, without remarkable complications, although patients with SBS often tend to have poor prognosis.
Short Bowel Syndrome ; Medicine, Kampo ; Treated with ; Therapeutic procedure ; Peritonitis

Pediatric intestinal failure causes growth failure and mortality in children due to the inability to maintain normal nutritional balance. Short bowel syndrome is the most common cause in pediatric cases, and the residual bowel length is important for predicting long-term dependence on parenteral nutrition. Based on the possibility that the process of intestinal adaptation in children can continue throughout the first five years, enteral autonomy should be prioritized in the management of intestinal failure. Despite the lack of well-established guidelines, careful advance of enteral feeding and a multidisciplinary team approach are critical for optimizing survival outcomes.
Child ; Enteral Nutrition ; Humans ; Mortality ; Parenteral Nutrition ; Short Bowel Syndrome

The two main diseases of inflammatory bowel disease are Crohn's disease and ulcerative colitis. The pathogenesis of inflammatory disease is that abnormal intestinal inflammations occur in genetically susceptible individuals according to various environmental factors. The consequent process results in inflammatory bowel disease. Medical treatment consists of the induction of remission in the acute phase of the disease and the maintenance of remission. Patients with Crohn's disease finally need surgical treatment in 70% of the cases. The main surgical options for Crohn's disease are divided into two surgical procedures. The first is strictureplasty, which can prevent short bowel syndrome. The second is resection of the involved intestinal segment. Simultaneous medico-surgical treatment can be a good treatment strategy. Ulcerative colitis is a diffuse nonspecific inflammatory disease that involves the colon and the rectum. Patients with ulcerative colitis need surgical treatment in 30% of the cases despite proper medical treatment. The reasons for surgical treatment are various, from life-threatening complications to growth retardation. The total proctocolectomy (TPC) with an ileal pouch anal anastomosis (IPAA) is the most common procedure for the surgical treatment of ulcerative colitis. Medical treatment for ulcerative colitis after a TPC with an IPAA is usually not necessary.
Colitis, Ulcerative ; Colon ; Crohn Disease ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Rectum ; Remission Induction ; Short Bowel Syndrome

Nutritional support is one of the major advances in the history of medicine in the 20th century. Since Dudrick and associates (1968) achieved the first successful nutritional support in puppies and human infants with short bowel syndrome, this technology has expanded as a gospel throughout the world. We can supply almost all of the macro-and-micro-nutrients and calories as much as we need. However, utilities of some specific nutrients have to be limited only by the defined metabolism and the pathophysiology under the concept of nutritional pharmacology. This paper is for a practical review of the nutritional support for physicians who are working in the primary and secondary care centers in this country.
History of Medicine ; Humans ; Infant ; Malnutrition ; Metabolism ; Nutritional Support* ; Pharmacology ; Secondary Care Centers ; Short Bowel Syndrome

The therapeutic target in Crohn's disease (CD) has been raised to the achievement of mucosal healing. Although effective treatments that target cytokines and other molecules has been widely used for CD, intestinal strictures are still a major cause of surgery. Endoscopic balloon dilation (EBD) is known to be an effective and safe intervention for intestinal strictures in CD. Since frequent intestinal resection often results in short bowel syndrome and can decrease the quality of life, EBD can help avoid surgery. EBD with a conventional colonoscope for Crohn's strictures of the colon and ileo-colonic anastomosis has established efficacy and safety. In addition, EBD using balloon-assisted enteroscopy has recently been applied for small bowel Crohn's strictures. Although the evidence is not strong, EBD may become an alternative to surgery in small bowel strictures in CD. EBD and other new methods such as self-expanding stent implantation for Crohn's strictures may be useful and safe; however, it is important to address several issues regarding these interventions and to establish a protocol for combined therapies.
Colon ; Colonoscopes ; Constriction, Pathologic ; Crohn Disease* ; Cytokines ; Quality of Life ; Short Bowel Syndrome ; Stents

The serial transverse enteroplasty (STEP) procedure is a novel technique to lengthen and taper the bowel in patients with short bowel syndrome. The advantages of STEP include not only technical ease and simplicity, but also the ability to repeat the procedure. Herein, we report a case of extreme short bowel syndrome that was successfully treated by the second STEP procedure. A 3-day old newborn girl underwent STEP because of jejunal atresia with the small bowel length of 15 cm, but her bowel elongation was not enough to escape from short bowel syndrome. At the age of 6 months, she underwent a second STEP procedure. The bowel lengthening by the second STEP made her tolerable to enteral feeding with body weight gain and rescued her from short bowel syndrome. This case showed that second STEP is very helpful in treatment of extreme short bowel syndrome.
Digestive System Surgical Procedures ; Female ; Humans ; Infant ; Intestinal Atresia/surgery ; Short Bowel Syndrome/radiography/*surgery

Chronic idiopathic inflamatory bowel disease, espcaially Crohn's disease, is frequently complicated with low gastrointestinal stricture. Besides medical treatment of active inflammation, there is no specific, conservative approach to this complication, Repetitive surgery with extensive resections, leading to short bowel syndrome, is often necessary. Balloons have been used for a variety of gastrointestinal stenoses including esophageal, small intestinal, and colonic stricture. Balloon dilation offers many theoretical advantages (safety, and patient comfort) over dilation with bougies. Especially, the availability of large diameter balloon dilators, which pass through the biopsy channel of standard endoscopes (through-the scope balloon or TTS balloon), has promised efficient direct-vision dilatation of strictures without the need of guide wires or fluoroscope. We report a case of colonic Crohn's stricture dilated successfully using TTS balloon catheter.
Biopsy ; Catheters ; Colon* ; Constriction, Pathologic* ; Crohn Disease ; Dilatation ; Endoscopes ; Humans ; Inflammation ; Short Bowel Syndrome

General treatment of short bowel syndrome is long-term total parenteral nutrition (TPN). But long-term TPN therapy produces thrombus, infection and obstruction of central veins and results in the life-threatening complications. Recently we experienced first case of small bowel transplantation in a 57-year old female with only 30 cm jejunum and distal part of colon to the splenic flexure who was suffering short bowel syndrome due to previous wide resection of small bowel. We report successful anesthetic management of small bowel transplantation in the patient with short bowel syndrome who has been suffered from life threatening complications due to long-term TPN therapy.
Colon ; Colon, Transverse ; Female ; Humans ; Jejunum ; Middle Aged ; Parenteral Nutrition, Total ; Short Bowel Syndrome* ; Thrombosis ; Veins