Recent Trends In The Management Of Intestinal Failure

Abstract

The small intestine is one the most important parts of gastrointestinal tract. It’s length vary from 300 to 850 cm between the duodenojejunal (DJ) flexure to the ileocaecal valve.The proximal 40 % is referred to as the jejunum; the remainder is the ileum.The small intestine has blood supply from the superior mesenteric artery, while venous drainage via the portal venous system, through the superior mesenteric vein .The main function of the small intestine is absorption of nutrients and fluids and digestion of food )Williams et al., 2013). Intestinal failure results from obstruction, dysmotility, surgical resection, congenital defect or disease-associated loss of absorption and is characterised by the inability to maintain protein-energy, fluid, electrolyte or micronutrient balance (Harrison et al., 2014). Intestinal failure can be classified by duration and potential reversibility (Hope Hospital classification) into 3 types. Type 1 which is common, Usually self-limiting, occurs in the perioperative period and needs nutritional support less than 14 days (Taylor et al., 2014). Type 2 Usually after major bowel resection ,Often associated with severe septic, nutritional and metabolic complications and Usually require parentral nutrition and multidisciplinary support to enable recovery.Type 3 which requires long-term parenteral nutrition (PN) and is most commonly secondary to Short Bowel Syndrome (SBS). Whilst this has been defined as small intestinal length less than 200 cm or 30% of prior length, it is irreversible type (Taylor et al., 2014). Prevention and management of type 1 intestinal failure (paralytic ileus) requires nasogastric tube with intractable vomiting and persistent abdominal distension, early postoperative ambulation, IV fluids and fluid balance monitoring , Epidural anesthesia has been shown to shorten duration of post-operative ileus (POI), gum chewing and the use of minimally invasive techniques have been shown earlier return to bowel function (Carroll et al., 2009)& (Spurrier et al., 2014). The multifaceted aetiology of intestinal failure requires astructured approach to management. A useful acronym for therapeutic strategy is SNAP (Sepsis, Nutrition, Anatomy, and Planned procedure) (Taylor et al., 2014).