PD271 - POST-TRAUMATIC INTESTINAL FAILURE – DIAGNOSTIC AND MANAGEMENT PEARLS

PD271

POST-TRAUMATIC INTESTINAL FAILURE – DIAGNOSTIC AND MANAGEMENT PEARLS

J. Y. J. Cheong^1,*, F. Koh¹

¹General Surgery, Sengkang General Hospital, Singapore, Singapore

 

Rationale: We present a case of intestinal failure (IF) secondary to traumatic bowel neuronal injury. This was managed within a new IF unit set up in Southeast Asia, with the use of dynamic Magnetic Resonance Enterography (MRE), Chyme Reinfusion System and multidisciplinary collaboration.

 

Methods: A 65-year-old male was involved in a traffic accident and sustained small bowel perforation with mesenteric hematoma in the mid-jejunal and ileocolic territories. He underwent exploratory laparotomy, small bowel resection with its associated mesentery and primary anastomosis. Post-operatively, the patient was initially managed as prolonged ileus requiring parenteral nutrition. During this time, the patient had fluctuating NG aspirates that pointed towards segmental paralytic ileus with a “reservoir” effect. On transfer to the local IF team, a dynamic MRE confirmed a paralytic segment at the previous small bowel anastomosis, likely secondary to neuronal injury from trauma with retained peristalsis in the distal and proximal intestines. The patient underwent surgical resection of the old anastomosis and double barrel jejuno-ileostomy stoma formation.

 

Results: The patient tolerated escalation of enteral nutrition with good stoma function. A chyme reinfusion system (Insides™ System) was introduced to recruit the absorptive capacity of the distal small bowel, allowing the weaning of PN and reactivation of colon out-of-circuit.

 

Conclusion: IF remains an uncommon and diagnostically challenging condition to manage. The use of dynamic imaging and multidisciplinary care within a specialized centre allows for better management of such patients.

 

References: 1. Solar H, Ortega ML, Gondolesi G. Current Status of Chronic Intestinal Failure Management in Adults. Nutrients. 2024;16(16):2648. doi:10.3390/nu16162648

2. Wang SZ, O'Daniel EL. Updates in Intestinal Failure Management. J Clin Med. 2025;14(9):3031. doi:10.3390/jcm14093031

Disclosure of Interest: None declared