PD375 - ENTERAL AUTONOMY IN ULTRA-SHORT BOWEL SYNDROME: GASTROSTOMY AS A KEY STRATEGY FOR INTESTINAL REHABILITATION

PD375

ENTERAL AUTONOMY IN ULTRA-SHORT BOWEL SYNDROME: GASTROSTOMY AS A KEY STRATEGY FOR INTESTINAL REHABILITATION

C. Marigo Costa^1,*, N. Galdino¹, M. H. D. S. A. Milman¹, L. V. L. Melo¹, M. J. C. Amaral¹, C. R. D. B. Paulichi¹

¹Hospital Regional de Cotia, Cotia, Brazil

Rationale: Ultra-short bowel syndrome is usually associated with permanent dependence on parenteral nutrition. Even in extreme anatomical conditions, enteral autonomy can be achieved through intestinal rehabilitation strategies.

Methods: Descriptive case report of a 39, female with acute mesenteric ischemia requiring extensive bowel resection, resulting in approximately 30 cm of small intestine without the ileocecal valve or right colon, followed by reconstruction of bowel continuity with an jejuno-transverse anastomosis. The patient developed severe malnutrition (BMI 16.79 kg/m²) and persistent diarrhea. A structured intestinal rehabilitation protocol was implemented, via gastrostomy for the administration of a polymeric diet in continuous low-flow infusion (10 ml/h) during the initial phase of the patient's intestinal adaptation. 

Results: The patient regained weight stabilizing BMI 20 kg/m². Long-term follow-up showed sustained nutritional stability and no recurrent hospitalizations.

Conclusion: Structured intestinal rehabilitation played a central role in achieving favorable outcomes, including early weaning from parenteral nutrition and significant improvement in nutritional and functional status. These results contrast with the historically poor prognosis of patients with ultra-short bowel, who traditionally require lifelong parenteral nutrition. Highlighting that gastrostomy with continuous low-flow administration of a polymeric diet can be considered as a central component of intestinal rehabilitation strategies, in addition to representing a cost-effective option for selected patients.

References: Tappenden KA. Anatomical and physiological considerations in short bowel syndrome: emphasis on intestinal adaptation and the role of enterohormones. Nutr Clin Pract. 2023

Vara‑Luiz F, Glória L, et al. Chronic intestinal failure and short bowel syndrome in adults: the state of the art. GE Port J Gastrenterol. 2024

Disclosure of Interest: None declared