10 year follow-up of a patient with short-bowel syndrome and parenteral nutrition-dependency

Introduction: In a subset of patients with short bowel sydrome with a residual length of small bowel shorter than 50cm the mainstay of nutritional theraphy is parenteral nutrition. In these cases, delivering regular paranteral nutrition may be challenging, partly because of the current regulations Hungarian health policy wich states that this type of treatment must be applied only in the frame of inpatient care facility. Long-term symptome free survival and good quality of life can be achieved with total parenteral nutrition in these patients. In this report we give an overiew of a 10 years clinical course of a patient with short bowel syndrome and parenteral nutrition dependency. Case report: In 1998, a 28 year old woman undervent laparatomy because of signs of small bowel obstruction. At surgery, a tumor invading the mesenterial radix and extensive small bowel necrosis was found. Resection of the tumor and the necrotized small bowel were performed, leaving only a funtional bowel segment of 70cm in length. During the past 10 years the patient recieved an oral diet of 3000kcal/day and the parenteral nutritional therapy was scheduled three times a week delivering a total of 4200kcal weekly. Her body mass index stabilized between 20 and 21. Parenteral nutrition was given exculsively on inpatient basis. In this period, the parenteral nuritional supply needed to be stopped for at least 3 months because of two episode of septic complications of intravenous line, and because the inconvenient time schedule for hospitaliation of the patient. Conclusion: Based on the present report, it can be concluded that long-term parenteral nutrition is highly beneficial on both nutritional status and quality of life of this subset of patients. The quality of life of these patients and the cost effectiveness of this therapy may be improved considerably by shifting the current hospital-based approach to home parenteral nutrition.