Intestinal failure

The outcome of intestinal failure due to short bowel syndrome has changed dramatically over the past half century. Following massive intestinal resection, survival of infants and children was rare and led Potts to conclude in 1955, “… an infant cannot part with more than about 15 in (38 cm) and live”. The development of total parenteral nutrition (TPN) introduced a new era in the management of children with short bowel syndrome. In 1968, Wilmore reported a pediatric case of parenteral nutritional support, and followed this with a series of 18 patients that were successfully treated with TPN for as long as 400 days. With new therapy came new complications, such as transient glycosuria and catheter-associated infections. The development of intestinal transplantation added yet another therapeutic option for children with intestinal failure. Goulet reported one of the first pediatric survivors of a cadaveric intestinal transplant in 1989. Advances in immunosuppression have improved both patient and graft survival over the past 15 years. The outcome of short bowel syndrome is difficult to determine in infants and children. First, the definition of short bowel syndrome is variable, sometimes based on absolute bowel length, percentage of bowel resected, or necessity for support with parenteral nutrition, a more functional parameter. Absolute length and even percentage of bowel remaining are imprecise parameters, as a range of “normal” bowel length exists.