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Parenteral nutrition
PMO-060 Restoring intestinal continuity after a small bowel infarction reduces the volume and frequency of parenteral nutrition
  1. A Rajendran1,
  2. Y K Cheung2,
  3. J M D Nightingale1
  1. 1Department of Gastroenterology, St Mark's Hospital, Middlesex, UK
  2. 2Specialist Pharmacist, St Mark's Hospital, Middlesex, UK

Abstract

Introduction A small bowel resection for ischaemia is one of the most common reasons for an admission to an intestinal failure unit (IFU) and for a patient needing home parenteral nutrition (HPN). The aim was to determine the changes in parenteral fluid, sodium and energy given to patients who have had a massive small bowel resection for ischaemia and in whom intestinal continuity is subsequently re-established by anastomosing the duodenum/jejunum to the remaining colon.

Methods Patients were identified using the IFU database. Case notes were retrospectively reviewed for the fluid, sodium and energy requirements before and after intestinal continuity was restored. Median values of the weekly requirements were calculated for 2 years after the continuity surgery had been performed.

Results 12 (5M) patients, mean age 51 years (range 30–77). 2 patients died at 12 months (one sepsis, one brainstem stroke) and one patient had not reached 24 months follow-up. The resection was for arterial infarction in eight patients, venous infarction in one patient, volvulus in one patient, incarcerated hernia in one patient and iatrogenic following surgery in one patient. Six patients had a small bowel length of <50 cm, nine patients had colon beyond hepatic flexure (five with ileocaecal valve) and three patients anastomosis to transverse colon. Two patients stopped PN completely at 1 month. These two patients had final small bowel lengths of 90 cm and 260 cm. There was a significant reduction in volume of feed and sodium given t1, 3–6, 12 and 24 months (p<0.05, Wilcoxon matched pairs test).

Conclusion Restoration of intestinal continuity to bring the colon into circuit results in less parenteral fluid (at least a litre/day) and sodium being needed but not necessarily the amount of energy. The number of nights where PN is required may be reduced in the 2 years after continuity has been restored.

Abstract PMO-060 Table 1

Median values of HPN requirements

Competing interests None declared.

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