Lessons learned from successful autologous gastrointestinal reconstruction in patients with intestinal failure: a case series

• Published in: BMC surgery Vol. 21; no. 1; p. 73
• Main Authors: Ashrafzadeh, Kiarash, Shafiekhani, Mojtaba, Azadeh, Nazanin, Esmaeili, Maryam, Nikoupour, Hamed
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 04.02.2021; BioMed Central; BMC
• Subjects: Abdomen; Absorptivity; Adaptation; Adult; Anastomosis; Anastomotic Leak; Autografts; Autologous gastrointestinal reconstruction; Bleeding; Care and treatment; Case Report; Colon; Complications; Complications and side effects; Contamination; Enterocutaneous fistula; Failure; Fistula; Gastrectomy; Gastric Bypass; Gastrointestinal surgery; Hospitals; Humans; Immunological tolerance; Intestinal Diseases - complications; Intestinal Diseases - surgery; Intestinal failure; Intestinal Fistula - surgery; Intestinal rehabilitation unit; Intestine; Intestine, Small - surgery; Intravenous administration; Laparotomy; Male; Middle Aged; Minerals; Morbidity; Nutrition; Ostomy; Parenteral nutrition; Patients; Peptic ulcer; Peptic ulcers; Peritonitis; Reconstructive Surgical Procedures - methods; Rehabilitation; Sepsis; Small intestine; Supplements; Surgeons; Surgery; Transplantation; Trauma; Treatment Failure; Iran; Autologous gastrointestinal reconstruction; Enterocutaneous fistula; Intestinal rehabilitation unit; Intestinal failure
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-021-01075-9

Intestinal failure (IF) is a rare but severe form of organ failure. The condition is defined as body's inability to absorb adequate fluids, macronutrients and minerals for growth and development, so that intravenous supplementation is necessary. A broad spectrum of diseases, trauma and complications of surgery might eventually end up with intestinal failure. Nowadays, intestinal failure patients are preferably cared for in intestinal rehabilitation units (IRU). Autologous gastrointestinal reconstruction (AGIR) refers to non-transplant operative management of IF patients designed to improve enteral tolerance and gut absorptive capacity. Herein we present five cases with complications of surgeries due to peptic ulcer bleeding, blunt abdominal trauma, obesity and gastric tumor. The surgeries were complicated by anastomotic leak, peritonitis and fistula formation. By adopting multidisciplinary decisions and special care for each complication, all the five patients were successfully managed and discharged. As presented, re-anastomosis in presence of abdominal contamination will probably fail. In patients with intestinal failure, PN should start as soon as possible to increase the success rate of future surgeries and prevent potential need for intestinal transplantation. We suggest referring patients with complicated outcomes of gastrointestinal surgeries to the IRUs to reduce morbidity and mortality.