Massive small-bowel resection in an infant: Long-term management and intestinal adaptation

~ CATTERED REPORTS of long-term survival of infants undergoing k.d massive resection of the small intestine may be found. 1~ Various surgical procedures have been developed that may be applied to such patients in an attempt to retard the rapid transit of intestinal contents. 9a~ However, in the growing child, and particularly the infant, it is believed that certain intrinsic compensatory changes may occur in the intestine that may eventually allow such a patient to support, in great part, his own nutritional requirements. The development of successful means of parenteral feeding insures that such patients may be supported through the initial postoperative period until such changes in the bowel occur. 1112 The patient presented herein is a child who has survived massive small intestinal resection for volvulus and in whom there is clinical, radiographic, and microscopic evidence of these compensatory changes in the intestine. The specific details of his management, as well as appropriate balance studies, will be discussed. CASE REPORT A 6-day-old infant was admitted to the Children's Hospital of Cincinnati because of persistent, nonbilious vomiting. There had been evidence of polyhydramnios. Physical examination revealed abdominal distention, absent bowel sounds, and an empty rectal ampulla. Radiographic examination showed multiple air-fluid levels consistent with intestinal obstruction, and barium enema showed incomplete colonic rotation. At operation, there was a 540-degree volvulus with infarction of the small intestine from 8 cm distal to the pylorus to within 8 cm of the ileocecal valve. Resection of the intervening necrotic small bowel was performed, and because there was questionable viability of the remaining