The challenges of managing and following-up a case of short bowel in eastern europe

Abstract

Introduction: This article reflects on the plight of patients with short bowel syndrome (SBS) in developing countries. SBS is life threatening, rare, complex and often not considered a priority by healthcare planners in the developing countries because of the high cost of treatment. Data was collected and analyzed from 3 different hospitals in two different countries (Romania and Austria) from November 2013 to February 2016 CASE PRESENTATION: The patient had an emergency surgery for volvulus as a result of an extensive ischemic necrosis, with just 80cm of the bowel left and no ileocecal valve after enterectomy. Despite intensive care and surgeries for anastomotic joint ischemic necrosis and intestinal adhesion with just 70cm of the intestine left after primary anastomosis, the patient remained in a catabolic state (metabolic acidosis, severe malabsorption and loss of nutrients, water and electrolytes through diarrhea) and was transferred overseas where two more surgeries (intestinal stomas) and good intensive care helped to achieve enteral autonomy at the optimal time.

Discussion: This immune-deficient patient was exposed to various types of bacteria (Klebsiella pneumoniae, Pseudomonas aeruginosa). Two years after surgery an acute enterocolitis with salmonella infection and resultant intestinal failure treated in patient's country of origin failed to achieve enteral nutrition warranting a second overseas transfer.

Conclusion: The lack of sufficient mucosal surface followed by long time intestinal adaptation process is crucial in determining bowel functional capacity. Long time hospital stay and cost was reduced through a parental home healthcare management training scheme.

Keywords: Bacterial overgrowth; Intestinal adaptation; Intestinal failure; Short bowel syndrome; Volvulus.