Der langstreckige Verlust von Dünndarm ist mit dem Leben nicht vereinbar. Aber
mit der langfristigen parenteralen Ernährung steht ein wirksames,
komplikationsarmes und mit guter Lebensqualität verbundenes Organersatzverfahren
zur Verfügung – vergleichbar mit der Dialyse beim Nierenversagen. Die
Zusammensetzung der parenteralen Substitution muss individuell für jeden
Patienten festgelegt werden. Die Pathophysiologie des Darmversagens und die
funktionelle Anatomie des Patienten stellen hierfür die Basis dar.
Abstract
Intestinal failure is defined as the reduction of gut function below the minimum
necessary for the absorption of macronutrients and/or water and electrolytes, such
that
intravenous supplementation is required to maintain health and/or growth. Intestinal
insufficiency is the corresponding condition that can be compensated by diet,
supplements and medication. Short bowel following extensive small intestinal resection
is the most common cause of intestinal failure. Parenteral nutrition is the effective
organ replacement therapy for intestinal failure, associated with few complications
and
good quality of life. Parenteral supplementation should be individualized and be put
together based on the individual remaining absorptive capacity of the intestine and
the
intestinal losses which are mainly a function of the functional anatomy – short bowel
–
jejunostomy (SB-J), SB – jejunocolonic anastomosis (SB-JC) or SB – jejuno-ileolcolonic
anastomosis (SB-JIC). Because of the functional importance of the colon SB-JC and
SB-JIC
are recently often summarized as SB – colon-in continuity (SB-CiC). Central venous
access is the Achillesʼ heel of parenteral nutrition. Tunneled single-lumen catheters
(Broviac or Hickman) are the catheters of choice. Taurolidine-containing catheter
lock
solutions reduce the risk of catheter-related infections. Pharmacological therapy
includes antisecretory, motility-inhibiting, and trophic strategies, as well as bile
acid binding in cases of resected terminal ileum. Reconstructive surgery (usually
reanastomosis of distal, disconected bowel segments) should be planned 6–12 months
after
the last operation, once postoperative conditions and the patient's overall health
have stabilized.
Schlüsselwörter
Kurzdarm - chronisch-entzündliche Darmerkrankung - parenterale Ernährung - Ileus -
intestinale Ischämie
Keywords
Short bowel syndrome - chronic inflammatory bowel disease - parenteral nutrition -
ileus - intestinal ischemia
