A description of the management and outcomes of infants with short bowel syndrome in a South African context

Abstract

Background. Intestinal failure because of congenital or acquired massive bowel loss is an extremely difficult problem to manage and has traditionally been associated with a very poor outcome. Objective. To describe the current management of short bowel syndrome (SBS) and the factors associated with survival and achievement of enteral autonomy in a South African context. Methods. A retrospective chart review of children managed with intestinal failure due to SBS was conducted at Inkosi Albert Luthuli Central Hospital, South Africa, from November 2015 to February 2023. Results. A total of 22 patients with intestinal failure were managed during the study period. The diagnoses included: type 4 jejunal atresia with 3b component (n=5; 22.7%); type 3b jejunal atresia (n=5; 22.7%); type 4 jejunal atresia without 3b component (n=3; 13.6%) and malrotation with volvulus (n=3; 13.6%). One patient each had necrotising enterocolits, gastroschisis with atresia, intussusception, type 1, jejunal atresia with volvulus, type 3a jejunal atresia and volvulus around an ileostomy. The median bowel length was 36.5 cm and average length of stay was 122 days. Enteral autonomy was achieved in 10 patients (45%) and survival in 9 patients (41%). Surgical complication requiring early re-operation (odds ratio 18) and bowel length ≤20 cm were associated with non-survival. Conclusion. A substantial proportion of children with intestinal failure can achieve enteral autonomy and survival in our context. The treatment process is, however, resource intensive. Avoiding early re-operation and bowel length >20 cm are associated with better survival.