Intestinal Failure and Rehabilitation

The diagnosis of short bowel syndrome is a significant life burden for the child and their caregivers. It typically results from the loss of a large segment of the small intestine, leading to malabsorption of nutrients. In the most severe form of intestinal failure, the patient is dependent on intravenous nutrition for survival. It was historically felt to always lead to a devastating outcome. Rapid advances in management have led to dramatic improvements in survival and to the achievement of both enteral tolerance and TPN independence in most children formerly felt to be beyond hope. Best managed in specialized centers, children are initially given full TPN support including specialized lipid preparations. Early restoration of intestinal continuity and initiation of enteral feedings are standard. Children should be monitored for progress in advancing enteral feedings and reducing TPN support. If this process fails, consideration of operative intervention and enteroplasty should be made. The approval in children of the intestinal growth factor teduglutide will further enhance the ability to achieve full enteral tolerance. When efforts at intestinal rehabilitation fail and children develop life-threatening complications, they are candidates for intestinal transplantation. An intensive multidisciplinary approach to management should prevent intestinal failure from ever again being considered a hopeless diagnosis.