Intestinal Failure

Intestinal failure occurs when your intestines can't digest food and absorb the fluids, electrolytes and nutrients essential to live. Intestinal failure is most often caused by short bowel syndrome, a problem that affects people who have had half or more of their small intestine removed due to injury or surgery to treat conditions such as trauma or mesenteric artery thrombosis. Intestinal failure also may be caused by digestive disorders, such as Crohn's disease or chronic idiopathic intestinal pseudoobstruction syndrome, which causes the bowel to malfunction.

If you have intestinal failure, you may receive all or most of your nutrients and calories intravenously through total parenteral nutrition (TPN). TPN is given through a catheter placed in the arm, groin, neck or chest. Patients on TPN may live for many years, but long-term use of TPN can result in serious complications, such as bone disorders, central venous catheter infections and liver disease. Our goal is to restore intestinal function to minimize and ultimately eliminate the need for TPN. Unfortunately, not every patient can be weaned from TPN. In these cases, we work to optimize the use of TPN and decrease the risk of complications.

Conditions

Patients who may benefit from being treated at the Intestinal Rehabilitation and Transplantation Program include:

• Adults with intestinal failure caused by:

  • Desmoid tumor, a benign growth of tissue that can develop in the abdomen
  • Fistulae or an abnormal duct that connects an abscess, cavity or hollow organ to the body surface or to another hollow organ
  • Inflammatory bowel disease, such as Crohn's disease where chronic inflammation occurs in the intestines
  • Multiple intestinal surgeries resulting in adhesions, motility problems that may lead to abnormal intestinal contractions and spasms
  • Pseudoobstruction that impairs gastrointestinal motility despite the absence of an actual obstruction
  • Radiation enteritis, a disorder of the large and small bowel that occurs during or after a course of radiation therapy to the abdomen, pelvis or rectum
  • Refractory celiac disease, also known as sprue, a digestive disease that damages the small intestine and interferes with absorption of nutrients from food
  • Superior mesenteric artery/vein thrombosis
  • Trauma
  • Tumor resection
  • Volvulus or an abnormal rotation of the intestine

• Children with intestinal failure caused by:

  • Aganglionosis, also known as Hirshsprung's, a deformity of the bowel where the nerves are missing
  • Diseases of the intestinal surface, such as congenital villous atrophy or microvillus inclusion disease
  • Gastroschisis, a congenital defect of the abdominal wall
  • Intestinal atresia a blockage or obstruction in the intestine
  • Midgut volvulus
  • Multiple intestinal surgeries resulting in adhesions and problems with motility and/or absorption
  • Necrotizing enterocolitis, a serious disorder affecting a baby's gastrointestinal tract
  • Pseudoobstruction and other motility disorders
  • Short bowel syndrome

Evaluation

Patients interested in the Intestinal Rehabilitation and Transplantation Program must complete an evaluation before qualifying for the program. Our team reviews each patient's medical history, including the primary diagnosis, previous surgeries, previous treatments and current nutritional status to determine whether he or she will benefit from intestinal rehabilitation.

The patient evaluation process includes:

• Consultations with a gastroenterologist and nurse practitioner, surgeon, nutritionist and social worker
• Laboratory tests
• Radiological tests
• Additional tests when necessary, such as endoscopy with biopsy, gastrointestinal motility testing, breath hydrogen testing for bacterial overgrowth or malabsorption and imaging tests, such as abdominal CT scan

After the evaluation process is completed, our team determines if the patient should be admitted into the Intestinal Rehabilitation Program. If the patient is admitted, a comprehensive, individual treatment plan is designed to best meet their needs.

Treatment

The Intestinal Rehabilitation and Transplantation Program offers a wide range services for adults and children. The type and length of treatment differs for each patient, depending on the needs and goals.

Services include:

• Counseling and education about intestinal rehabilitation
• Drug and diet modification to train the small intestine to absorb more nutrients
• Consultations to help assess and correct nutrient deficiencies and prevent damage to kidneys, bones and liver
• Management of TPN to avoid complications
• Placement and management of catheters in veins called central venous lines
• Surgery, such as bowel lengthening and tapering that can help increase bowel length and nutrient absorption
• Intestinal transplants
• Consultations with doctors caring for patients with intestinal failure

For patients dependent on TPN, the program provides services to help patients:

• Reduce or eliminate the need for TPN
• Reduce complications associated with TPN
• Decrease diarrhea and/or vomiting
• Gain weight
• Decrease the need for intestinal transplantation